Last year, CMS issued CR 12889 which instructs Medicare Administrative Contractors (MACs) to edit for validating the attending physician’s NPI includes hospice claims. While the FY2024 proposed rule does include a proposal that physicians ordering and certifying hospice care be enrolled in PECOS or validly opt-out, as of right now hospice attending physicians are not required to be PECOS enrolled. The edit, which went into effect April 3, the edit is causing hospice claims to be rejected when the physician’s NPI is not found in the PECOS file. CMS clarified that the edit was being applied inappropriately to hospices. CMS is in the process of fixing this so the edit does not apply to hospice. Additionally, information on the correction should be available within the next 30 days. Impacted providers will need to resubmit any impacted claims prior to the fix that received the edit for this.
