HHA Claim Edits Expanded

Independent and provider-based home health agencies (HHAs) will soon need to be more diligent about certain information listed on claims when billing for services provided to Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) has instructed regional home health intermediaries (RHHIs) to implement expanded edits beginning Jan. 1, 2011.

CMS claim editing is being expanded to verify that attending physicians listed on HHA claims are eligible for Medicare reimbursement. To prevent HHA claims from being denied, make sure the attending physician listed on each HHA claim:

  • has a valid National Provider Identifier (NPI);
  • is enrolled in Medicare; and
  • is either a doctor of medicine or osteopathy or a doctor of podiatric medicine.

Do this now: Providers should verify their enrollment in Medicare’s Internet-based Provider Enrollment, Chain, and Ownership System (PECOS).

The expanded edits will be phased in over the next two years:

Phase 1 (Oct. 1 – Dec. 31): RHHIs are instructed to issue a warning if the above requirements aren’t met.

Phase 2 (on/after Jan. 1, 2011): RHHIs are instructed to deny claims if the above requirements aren’t met.

Please read revised MLN Matters article MM6856, issued Aug. 30, for complete details.


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