Home Health & Hospice Week

Don’t forget to check the doc’s specialty code.

If you’re accessing only the “Order and Referring” data file at https://data.cms.gov to confirm your physicians’ information required on the home health claim, you’re not going far enough to protect your claims from related denials.

Step 1: You do indeed need to confirm the doc’s National Provider Identifier, last name, and first name in that file, HHH Medicare Administrative Contractor CGS says in a new article on home health ordering and referring requirements.

Step 2: But don’t stop there. Next, you must confirm the physician’s specialty code via the NPPES website at https://npiregistry.cms.hhs.gov, CGS instructs on its website. “Use the information under the ‘Primary Taxonomy’ field to cross reference the list … of valid home health ordering/referring specialty codes,” the MAC continues.

Step 3: Make sure the ordering/referring file matches your physician’s data exactly for these three items before submitting your claim: NPI, the first four letters of the physician’s last name; and the first letter of the physician’s first name, CGS directs.

For a list of valid physician specialty codes, see CGS’s article at http://cgsmedicare.com/hhh/pubs/news/2017/0317/cope2674.html.

Heads up: “There may be times when a physician has an enrollment record in PECOS, but they are not located on the ordering/referring data file,” CGS allows. “This is often due to the physician not completing the necessary information in PECOS which allows them to be included in the ordering/referring data file. You may want to contact the physician and ask that they complete the necessary information in PECOS,” the MAC suggests.

You’ll know if your claims deny due to physician data problems when you see reason code 37236, CGS says. An adjustment will carry a 37237 reason code.