New Reporting Requirement for Medicare Home Health Claims

Effective July 1, 2014, the Centers for Medicare and Medicaid Services (CMS) will require that all Medicare home health claims contain the name and National Provider Identifier (NPI) of the physician who certifies/re-certifies the patient's eligibility for home health services, as well as the NPI and the name of the attending physician who signs the home health plan of care. For complete details, please refer to CMS Transmittal 2833.

By way of background, in 2011, CMS began allowing the attending physician in an acute/post-acute care setting to refer, order and certify the patient’s home health care services, as well as signing the plan of care. The acute/post-acute care attending physician may then “hand off” the patient to the community-based physician who will continue to oversee the necessary aspects of the continuing home care services.

Effective for claims with episodes that begin on or after July 1, the home health agency must report the NPI and name of the physician who certifies/re-certifies the patient's eligibility for home health services, if this physician is different than the one signing the patient's plan of care. The home health agency must also continue to report the NPI and name of the physician who signs the patient's plan of care. In most instances, this will likely be one and the same doctor, in which case the home health agency only needs to report the NPI and the name of the physician in the claim's fields that correspond to that of the physician signing the plan of care as the “attending physician."

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827