Long-Term Care, Home Health & Hospice

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Home Health Agencies’ Claims for Ordered/Referred Services Must be Billed Using Individual Physician’s Name and NPI

Posted on July 24, 2012 in Long-Term Care, Home Health & Hospice

Written by: Selby, Todd J.

In the near future, Regional Home Health Intermediaries (RHHIs) and Parts A and B Medicare Administrative Contractors (A/B MACs) will be contacting home health agencies (HHAs) that have previously submitted claims for ordered or referred services using a group name and national provider identifier (NPI).  HHAs will be informed they should begin submitting such claims using the ordering physician’s name and NPI, not a group name and NPI.  Once the Centers for Medicare & Medicaid Services (CMS) implements the edits for ordering/referring services into the coding system, claims submitted under a group NPI will be denied.

To facilitate this change, CMS recently contacted physicians who provide home health services and reminded them that claims for ordered/referred services must be billed under their name and individual NPI.  Therefore, they should provide their NPI to the home health agency(ies) for which they provide services.

If you have questions or concerns regarding the foregoing or would like additional information, please contact your regular Hall Render attorney, or Todd Selby at or 317.977.1440; Brian Jent at or 317.977.1402; or David Bufford at or 502.568.9368.