An analysis by a Medicare administrative contractor (MACs) shows that the overall percentage of claims affected by a new edit is likely to be small, but most agencies would see at least some denials.
 
The new system edit will deny any home health claims where the certifying physician isn’t listed in the provider enrollment, chain and ownership system (PECOS). The edit will apply to services provided on or after May 1.
 
In a report released March 22, MAC CGS says it found that between September 2012 and February 2013, approximately 4% of claims received remark code N272. Since 2009, CMS has flagged claims that would fail the edit with this code, which indicates that the physician’s information is invalid or incomplete based on the ordering/referring file.
 
But CGS also adds this: Three out of four agencies would have received at least one denial if the edit had been turned on at the time.
 
For more on what preventable agency errors caused some of the CGS denials, as well as additional guidance on how to reduce your denial risk, turn to an upcoming issue of Home Health Line.