tci Medicare Compliance & Reimbursement - 2014 Issue 2

Home Health Reimbursement: Check Physician Enrollment In PECOS Before Accepting Referral

Lack of clarity on how the edits will impact RAPs. There is still some measure of confusion which the Centers for Medicare & Medicaid Services (CMS) needs to clarify with regard to how the PECOS edits will impact Requests for Anticipated Payment (RAPs) for episodes starting Jan. 6 or later. The edits affect claims with a “From” date of Jan. 6 or later. That means your end of episode claims for episodes that began before Jan. 6 will not be affected by the newly enforced requirement. Home Health & Hospice Medicare Administrative Contractor CGS says that “if...

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