Several Barnestorm customers are receiving denials, due to physician information on the claim.  Please review the information below, and follow up with the more detailed article by Medicare (listed below).

Medicare Home Health Requirement:

To receive payment for home health services, any Medicare-enrolled Home Health Agency must file claims containing the name and National Provider Identifier (NPI) of the physician who ordered the service.   When billing for an ordered home health service:

·         The individual physician must be enrolled in Medicare or in an opt-out status. You can verify that the ordering physician is enrolled in Medicare by reviewing the Ordering/Referring Report on the CMS website.

·         The NPI used for ordering must be for an individual physician (cannot be a group or organizational NPI). 

·         The individual physician must be of a specialist type that is eligible to order. These individuals include:

o   Doctors of Medicine or Osteopathy

o   Doctors of Podiatric Medicine

Failure to meet the requirements mentioned above will result in denied claims once the automatic edits are activated. For additional information, review the Medicare Learning Network’s “Medicare Enrollment Guidelines for Ordering/Referring Providers” fact sheet.