Medicare Compliance & Reimbursement

• Good news for hospices that submit claims with physician services: A claims system fix for a doc service-related error will be here sooner than originally thought.

The problem: An error with the Outpatient Code Editor is causing hospice claims that contain physician services to return to provider with reason code W7072.

The solution: The system fix was originally scheduled for October, but now has been moved up to July, notes regional intermediary Cahaba GBA on its Web site.Until then, use the following workaround to get such claims paid: First, remove the physician services from the claim and F9 your claim, Cahaba instructs. Then "once the claim has processed (P B9997), you may submit an add-on claim (TOB 8X5) for the physician charges which were removed from the claim," the intermediary says.

• Keep an eye on the Federal Register as you use Medicare's Internet-based Provider Enrollment, Chain and Ownership System (PECOS), analysts who have reviewed the process tell MCR.

Background: CMS issued a press release on April 1 from Valerie Haugen, a director with CMS, announcing that the person filling out the PECOS form need not be the physician or non-physician practitioner, but "may be an employee of the provider or supplier organization, or an employee of a separate organization."

The update: During an April 7 CMS Open Door forum, CMS reiterated its position that the physician doesn't need to personally fill out the PECOS form. However, CMS press releases and phone conferences don't make the rule legal, says Robert Burleigh, CHBME, president of Brandywine Healthcare Consulting in West Chester, Pa.