In 2022, Centers for Medicare & Medicaid Services (CMS) issued CR 12889, which instructs Medicare Administrative Contractors (MACs) to validate the attending physician’s national provider identifier number prior to approval for payment included hospice claims (aka imposed an “edit” on claims processing). While the Fiscal Year 2024 proposed rule does include a proposal that physicians ordering and certifying hospice care would be required to be enrolled in PECOS or validly opt-out, as of right now hospice attending physicians are not required to be PECOS-enrolled.

The edit, which went into effect April 3, caused hospice claims to be rejected when the physician’s NPI was not found in the PECOS file. CMS clarified that the edit was being applied inappropriately to hospices and they are in the process of fixing this glitch so that the policy will not apply to hospice. Additionally, information on the correction should be available within the next 30 days.

Impacted providers will need to resubmit any claims submitted prior to the fix by CMS.