Home Health & Hospice Week
Add Certifying Physicians To Your PECOS Edit Checklist
Don’t forget to prepare for the next wave of so-called PECOS edits, which hits next month.
Starting July 1, home health agencies “are required to report the [National Provider Identifier number] of the physician who certifies/re-certifies the patient’s eligibility (Certifying Physician),” HHH Medicare Administrative Contractor CGS reminds agencies in its June newsletter for pro-viders. “This is in addition to reporting the NPI and name of the physician who signs the patient’s plan of care (Attending Physicians) when the attending physician is not the same physician who certified/re-certified the patient’s eligibility to receive services under the Medicare home health benefit.”
Bottom line: “For episodes that begin on or after July 1, 2014, the certifying physician and the attending physician must be enrolled in the Provider Enrollment, Chain and Ownership System (PECOS) or have validly opted out as of the date of service reported in the claim.” CGS says.
If you get claims bounced back after the edits take effect, remember that you must follow a new process when a claim is denied with reason code 37236 or 37237, CGS emphasizes in a separate article in the newsletter. “The only recourse to receive Medicare payment for this type of denial is to request a Reopening,” CGS stresses. “Do not resubmit a new claim or submit a redetermination request.”
Read the articles in the MAC’s newsletter at http://cgsmedicare.com/hhh/pubs/mb_hhh/2014/HHH_bulletin_june14.pdf.
Home Health & Hospice Week
- OASIS:
Take An OASIS Submission Break Over The Holidays
Claims system glitches, COPs, CAHPS also addressed in Open Door Forum. In case you didn’t [...] - Hospice:
Submit Your Concurrent Care Demo Application This Month
HIS Manual, NOE deadline also raised in ODF. If you want to get in on [...] - Reimbursement:
Medicare Overpays Hospitals $32 Million For Home Care Patients, OIG Says
Medicare claims system fails to apply postacute transfer policy. Hospitals are feeling pressured on both [...] - HIPAA:
Avoid Paying The HIPAA Bill For Your Associate's Mistakes
Warning: Private lawsuits can be just as costly as federal HIPAA fines. You might think [...] - Compliance:
Do Your Pre-Existing BA Agreements Need An Update?
Start work now to meet the September deadline. Don’t let your BAAs put you at [...] - Industry Notes:
OIG Puts Employee Background Checks Under The Microscope
Popular press isn’t happy that 10 states require no checks on home care workers. If [...] - Industry Notes:
Add Certifying Physicians To Your PECOS Edit Checklist
Don’t forget to prepare for the next wave of so-called PECOS edits, which hits next [...] - Industry Notes:
Hospitals Sue HHS Over Long ALJ Wait
A lawsuit from the American Hospital Association aims to shorten wait times for appeals. Background: [...] - Industry Notes:
Excluded Staffer Costs Provider Six Figures
Beware: Even if you don’t self-disclose your employment of a staffer excluded from Medi-care, you [...] - Industry Notes:
Test ICD-10 Claims After October, CMS Suggests
Don’t feel like you have to hold off on claims testing for ICD-10, just because [...] - Industry Notes:
Religious Meetings Lead To Employee Lawsuit
False claims and Wage and Hour violations aren’t the only things that may land you [...] - Industry Notes:
Hospital Agency Expands Service Area
Sonoma Valley Hospital in California is expanding its home care services into Marin and Napa [...] - Industry Notes:
Detroit HHA Owner Draws 6-Year Prison Sentence
A year after pleading guilty to Medicare fraud, a Detroit home health agency owner and [...]
