HH Denials for Incorrect Billing of Attending/Other Physician Names and NPIs

This article was previously published on the Palmetto GBA website due to an increase in Comprehensive Error Rate Testing (CERT) contractor denials related to improper billing of home health claims. As a reminder, this article is being republished to assist providers in understanding how to correctly bill home health claims.

Please ensure that the claim (UB-04) is completed with the correct “Attending” and “Other” physician name/National Provider Identifier (NPI) as follows:

• The “Attending” provider name/NPI entered on the claim should match the physician name/NPI who signed the home health plan of care. If the physician name/NPI on the home health plan of care document does not match the claim, the previously paid claim will be adjusted to deny in full.
  
  
• The “Other” provider name/NPI entered on the claim should match the physician/NPI who signed the certification/recertification for eligibility. If the physician name/NPI on the home health certification/recertification document does not match the claim, the previously paid claim will be adjusted to deny in full.
  
  
• If the physician who signed the plan of care is the same as the physician who signed the certification/recertification, then only the “Attending” provider name/NPI is required to be entered on the claim.