Medicare Compliance & Reimbursement

Get friendly with your physician databases. You won't have any financial recourse if Medicare denies an episode that's supposed to pay thousands due to referring physician eligibility. So you'd better make sure your claims are free of such problems. "When it turns out that the physician has been excluded from Medicare or is not properly enrolled (or opted out), the penalty falls on the home health agency because accepting orders from an appropriately credentialed physician is an administrative requirement," notes Chicago-based regulatory consultant Rebecca Friedman Zuber. Heed this expert advice to head off claims denials related to physician eligibility: 1. Check for the doc's NPI and PECOS record. The deadline for PECOS edits has been indefinitely postponed, points out consultant Judy Adams with Adams Home Care Consulting in Chapel Hill, N.C. That means you won't receive a returned claim at the outset when a physician isn't enrolled -- you could provide [...]