- Medicare Hospice Quick Reference Sheet
- Hospice Certifying Physician Medicare Enrollment Information
- Hospice Claim Reporting Requirements for Attending and Certifying Physicians
- 17729 Hospice Claim Edit for Certifying Physicians
- Hospice Notice of Election Termination/Revocation (Type of Bill 8xB)
- Hospice Room and Board Denials
- Professional Services During a Patient Hospice Election
- Counting 60-Day Election Periods
- Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement
- Hospice Billing Codes Chart
- Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77
- Hospice Notice of Change of Ownership
- Filing an Electronic Notice of Change of Ownership (TOB 8XE)
- Hospice Change of Ownership
- Filing an Electronic Notice of Cancelation (Type of Bill 8XD)
- Filing an Electronic Notice of Transfer (Type of Bill 8XC)
- Counting 60-Day Election Periods - Leap Year
- Hospice Site of Service Codes
- Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related To Terminal Diagnosis)
- Hospice Visit Reporting
- The Medicare Hospice Benefit: Effects on Other Provider Types
- Counting 90-Day Election Periods - Leap Year
- Reporting Hospice Discharges, Revocations and Transfers
- Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims
- Hospice Claim Submission Job Aid
- Counting 90-Day Election Periods
- Hospice Quality Reporting Program
- Filing an Electronic Notice of Election (Type of Bill 8XA)
- Value-Based Insurance Design Model Hospice Benefit Component Overview
- Documentation for Hospice Transfers
- Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines
- Canceling a Hospice Notice of Election
- How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period
- Hospice Payment Rates
- Billing Medicare for a Denial - Condition Code 21
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
17729 Hospice Claim Edit for Certifying Physicians
Effective for hospice claims with claim ‘From’ dates on or after 6/3/2024, new claim edits have been implemented per CR 13342 to enforce CMS’ rule to deny hospice claims if the name and NPI of the certifying physician in the ATT PHYS field is not in the PECOS. as an enrolled or opted-out provider. The hospice physician and attending physician need to be enrolled/opted-out at the time they make the certification or recertification of hospice care for a patient.
This is what providers will see as the narrative for Reason Code 17729: ATT PHYS NPI data against the PECOS Enrolled Physicians File, Type A records for Hospice claims, TOB 81X and 82X (excluding 8XA, 8XB, 8XC, 8XD and 8XE) with a Statement From Date on or after 6/3/2024.
This Reason Code will edit the ATT PHYS NPI data against the PECOS Enrolled Physicians File, Type A records for Hospice claims, TOB 81X and 82X (excluding 8XA, 8XB, 8XC, 8XD and 8XE) with a Statement From Date on or after 06/03/24 and will assign when:
- Occurrence Code 27 and associated date are present on Claim Page 02 (MAP1032) and the Occurrence Code 27 date does not fall on or after the Physician's Effective Date but before the Termination Date on the PECOS Enrolled Physicians Inquiry Screen (MAP1B52).
Or
- Occurrence Code 27 and associated date are not present on Claim Page 02 (MAP1032) and the claim Statement From Date is not on or after the Physician's Effective Date but before the Termination Date on the PECOS Enrolled Physicians Inquiry Screen (MAP1B52).
Or
- The ATT PHYS NPI and/or the first four characters of the Physician's last name on Claim Page 05 (MAP1035) does not match the NPI and/or the first four characters of the Physician's last name on the PECOS Enrolled Physicians Inquiry Screen (MAP1B51).
You can avoid this reason code by reviewing the CMS Ordering and Referring Data Set for the attending physician (ATT PHYS) entered on the claim to ensure:
- The physician is listed on the CMS Order and Referring Dataset with a “Y” in the hospice column. If the physician has an “N” in the hospice column, they are not eligible to certify for hospice and the claim cannot be approved for payment.
- Their NPI is correct
- The first four characters of their last name exactly matches the dataset. Also verify that the first and last name are not entered in reverse on the claim.
- The name and NPI is not for a nurse practitioner (NP) or physician assistant (PA). NPs and PAs cannot certify patients for hospice. A physician must be entered.
If the physician entered in the ATT PHYS field on the claim is not in the PECOS as an enrolled or opted-out physician, they will not be listed on the dataset and the claim cannot be approved for payment.
Related Content
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, “Coverage of Hospice Services Under Hospital Insurance”, Section 20.1
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11, “Processing Hospice Claims”, Section 30.3
- Change Request 13342: Implement Edits on Hospice Claims
- CMS Hospice Certifying Enrollment Questions and Answers (Q & A) Document
Posted 7/1/2024