CMS: Denial Edits for Physicians Certifying HHA Services

Effective July 1, 2014, Phase 2 ordering and referring denial edits will apply to attending physicians, who sign a patient’s plan of care, as well as certifying physicians, who certify/re – certify a patient’s eligibility to receive services under the  Medicare home health benefit, as reported on Home Health Agency (HHA) claims. Currently, these edits are only applicable to the attending physician. The edits will check to ensure that attending and certifying physicians have valid National Provider Identifiers (NPIs) and are eligible to order and refer the HHA items and services on the claim. These edits will deny the claim when this information is missing or invalid.

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