Part B Insider (Multispecialty) Coding Alert
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In May 2010, CMS published an interim final rule based on the Affordable Care Act, requiring physicians who ordered home health and certain other services to be enrolled in PECOS with a valid National Provider Identifier (NPI) number for claims to be paid. CMS planned to begin editing for docs' NPIs and PECOS information in January 2011. However, CMS postponed those edits indefinitely when physicians had inordinate difficulty enrolling in the system, among other problems.
Last month, CMS issued a final rule restating those requirements, and CMS reps reportedly told a trade association that the edits would be coming relatively quickly.
In a new e-mail message to providers, CMS reiterates the requirements for physicians to order home health services -- Medicare enrollment, a valid individual NPI, and the correct specialty (Doctors of Medicine or Osteopathy or Doctors of Podiatric Medicine). "Failure to meet the requirements ... will result in denied claims once the automatic edits are activated," CMS warns.
Part B Insider (Multispecialty) Coding Alert
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