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4,676 Results for 2023
  • Posting Date: 07/29/2025
    55H2B

    Avoiding/Correcting This Error Ensure the submitted documentation supports the beneficiary is confined to the home.  An individual shall be considered “confined to the home” (homebound) if the following two criteria are met: Criterion [...]

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  • Posting Date: 07/29/2025
    17730

    Avoiding/Correcting This Error This edit is applied if the NPI and first four letters of the physician’s last name submitted on the claim in the Referring field do not match the physician’s NPI and first four letters of the physician’s last [...]

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  • Posting Date: 07/29/2025
    55H1R

    Avoiding/Correcting This Error Review coverage and billing guidelines for the NOE to ensure that your NOEs are accurately billed. Related Content CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Section [...]

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  • Posting Date: 07/29/2025
    55H1L

    Avoiding/Correcting This Error Clinical progress notes should show evidence of a steady decline or downward trajectory in the beneficiary’s clinical status over time. Documentation should be objective, measurable and must support a life [...]

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  • Posting Date: 07/29/2025
    37236

    Avoiding/Correcting This Error Verify eligibility of the attending/ordering physicians in PECOS. Print that verification and make it part of the medical record. If applicable, submit a reopen request to the Appeals Department indicating error [...]

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  • Posting Date: 07/29/2025
    56900

    Avoiding/Correcting This Error This reason code can and should be prevented. When providers receive an ADR, respond according to the date listed in the ADR. Providers should start gathering the documentation being requested immediately. This [...]

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  • Posting Date: 07/29/2025
    32072

    Avoiding/Correcting This Error The attending physician reported on your claim must be active in PECOS to be considered a valid attending physician for the home health patient.

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  • Posting Date: 07/29/2025
    55HTP

    Avoiding/Correcting This Error Verify that the initial certification is complete and includes all necessary elements, such as the patient’s homebound status, the need for skilled services, and a face-to-face encounter with a physician or [...]

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