NHIC Corp, the Medicare Administrative Contractor for Jurisdiction 14 A/B/MAC, held a conference call for home health and hospice to clarify information and provide the opportunity for questions.
Change Request (CR) 6856 clarified the scope of claims editing and PECOS for home health. During Phase I (October 1, 2010-December 31, 2010), when a claim is received, the following will occur:
The RHHI will determine if an attending physician is required for the billed service; if so, that the attending physician’s NPI in on the claim. If the NPI is present, Medicare will verify that he/she is on the national PECOS file. If the attending physician is not on the PECOS file, the claim will continue to process but a message will be included that the claim may not be paid in the future.
After January 1, 2011, if the billed service requires an attending physician and the NPI is not on the claim, the claim will not be paid. If there is an NPI, Medicare will also verify with the national PECOS file. If the physician is on the PECOS file but not a doctor of medicine, osteopathy, or podiatry the claim will not be paid. CMS is still silent as to claims payment if the physician is not in PECOS or is on the “pending file” after January 1, 2011.
Providers were also reminded about CR 6960 and the timely filing requirements that were changed by the Patient Protection and Affordable care Act (PPACA). Providers now have one year to file a Medicare claim, based on date of service. In the case of providers that use “From” and “Through” dates, CR 7080 clarified that the “through” date is used.
Providers with questions regarding these issues or any others should contact the Customer Call Center at 866/289-0423 or for medical review-related questions, the Clinical Voice mail Box at 800/338-6101.
Check the NHIC website at http://www.medicarenhic.com to register for upcoming educational sessions including home health billing on September 15th; Clinical Medical Review Findings on November 17th; and an ACT Call (Ask-the-Contractor) on October 13th.