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Additional Implementation Edits on Hospice Claims for Hospice Certifying Physician Medicare Enrollment

The purpose of this Change Request (CR) is to implement additional edits on Hospice Claims for Hospice Certifying Physician Medicare Enrollment. As of May 1, 2024, hospice certifying physicians, including hospice physicians and hospice attending physicians are required to be enrolled in Medicare or validly opted-out at the time they make the certification or recertification of hospice care for a patient.The additional edit requirements in this CR will check the REF PHYS NPI field as well as the ATT PHYS NPI field on the hospice claim to ensure the certifying physician as well as the attending physicians are enrolled or validly opted-out in Medicare for payment.

Download the Guidance Document


Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: April 19, 2024

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.