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January 25, 2018


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Medical Coding News Archives

Edits to Verify CAH Provider Enrollment in Medicare

 
September 3, 2010:

The Centers for Medicare and Medicaid Services is expanding claim editing to verify that the attending, operating, or other physician or nonphysician practitioner rendering services to patients in a critical access hospital (CAH) is eligible and enrolled in Medicare. Toward this end, the agency will allow the Fiscal Intermediary Shared System (FISS) to match data on a provider’s claim to the national Provider Enrollment, Chain and Ownership System (PECOS) file.

CMS will implement the new editing procedures in two phases. During phase 1 the agency will pay the claim when the billed service requires a type physician or nonphysician provider listed above even though the information is not on the claim. However, a remittance advice message will notify the billing provider that these claims may not be paid in the future if the required data for this type of physician or nonphysician provider are not provided properly or if the information is missing on the claim. Phase I will be implemented January 1, 2011. Phase 2, which will become effective April 1, 2011, will not allow the claims to be paid.

 

 
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