Expansion of the Current Scope of Editing for Attending, Operating, or Other Physician or Non-Physician Practitioner Providers for Critical Access Hospital (CAH) Claims Processed by Medicare Fiscal Intermediaries and Part A Medicare Administrative Contractors (A/B MAC)
The CMS is expanding the claim editing to meet the Social Security Act
requirements for the attending, operating, or other physician or non-physician practitioner when a plan of
treatment is needed and submitted from a CAH. The expansion will verify the attending, operating, or other
physician or non-physician practitioner provider on a CAH claim is eligible and enrolled in Medicare by
allowing FISS to match data on a provider billed claim to that of a national PECOS file. The editing
expansion will be done in two phases. Phase 1 will allow a claim to be paid, if the billed service requires this
type physician or non-physician provider listed above and the information is not on the claim. A remittance
advice message will notify the billing provider that claims of this nature may not be paid in the future if the
required data for this type of physician or non-physician provider is not provided accurately or is missing on
the claim. Phase 2, will not allow the claims to be paid.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 10, 2010
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