New FISS Consistency Edit to Validate Attending Physician NPI

Effective for claims received by the Centers for Medicare & Medicaid Services on or after April 1, 2013, home health and hospice agencies will be subject to a new edit. The new edit will verify that the National Provider Identifier (NPI) number in Field Locator (FL) 76 is not the billing NPI of the home health or hospice agency.

Providers are required to include the attending physician’s NPI in this FL. Previously providers were permitted to report their billing NPI in the field as some were experiencing difficulties obtaining the physician’s NPI. That practice will no longer be permitted.

CMS assigns an implementation date of Jan. 7, 2013 to this Change Request (CR) but identifies in the Policy section of the CR that the edit is effective for claims received on or after April 1, 2013. There is a date discrepancy between the CR and the MLN article. The National Association for Home Care & Hospice has sought clarification and will provide further information as soon as it is available. The full CR can be accessed here and the associated MLN article can be accessed here.

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