- 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
Hospice Claim Reporting Requirements for Attending and Certifying Physicians
Under CMS’ current guidelines, the hospice medical director or the hospice physician, and the attending physician (if the beneficiary has one) must initially certify the patient’s terminal condition. The guidance in CR 13342 is letting providers know the claims system will now be editing for the physician NPIs reported on the claim. CMS is making sure certifying physicians, including hospice physicians and hospice attending physicians, are enrolled in or opted-out of Medicare before paying for their hospice services. 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.
Effective for claims submitted June 3, 2024–October 6, 2024:
- The hospice attending and certifying physicians will be subjected to ordering and referring denial edits
- The name and NPI of the certifying/recertifying physician should be reported in the ATT PHYS field
- FISS will look at the ATT PHYS field and compare the name and NPI reported in this field to PECOS
- You can verify the status of the NPI in the CMS Ordering and Referring Data Set
- If the physician in the ATT PHYS field is not in the PECOS hospice ordering and referring files, the claim will edit for reason code 17729.
Effective for claims submitted on or after October 7, 2024 with dates of service June 3, 2024 or later for initial certifications:
- FISS will check the REF PHYS NPI field and the ATT PHYS NPI field on hospice claims for initial certifications to make sure the certifying physicians, including hospice physicians and hospice attending physicians, are enrolled in or opted-out of Medicare.
- Report the name and NPI of the certifying physician in the REF PHYS field
- Report the name and NPI of the attending physician in the ATT PHYS field (if the patient has chosen one)
- If the certifying and attending physician are the same, only report the name and NPI of the physician in the ATT PHYS field
Effective for claims submitted on or after October 7, 2024 with dates of service June 3, 2024 or later for subsequent certifications:
- Report the name and NPI of the certifying physician in the REF PHYS field
- Report the name and NPI of the attending physician in the ATT PHYS field (if the patient has chosen one)
- If the patient doesn’t have an attending physician, report the name and NPI of the certifying/recertifying physician in the ATT PHYS field
Edits will only apply to both fields if both the ATT PHYS and REF PHYS fields are completed.
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
- Change Request 13531: Additional Implementation Edits on Hospice Claims for Hospice Certifying Physician Medicare Enrollment
- MLN Matters Number MM13531: Hospice Claims Edits for Certifying Physicians
- CMS Hospice Certifying Enrollment Questions and Answers (Q & A) Document
Posted 7/1/2024