tci Medicare Compliance & Reimbursement - 2014 Issue 5

Home Health Reimbursement: Get Claims Reviewed Without Going Through the Appeals Process

Home health agencies have something to cheer about. Good news: You can get some PECOS edit denials fixed quickly and without going through the cumbersome (and expensive) appeals process. “Claims are denied with reason code 37236 or 37237 when the NPI and/or physician’s last name or first name submitted on the home health claim does not match the physician’s information at the Provider Enrollment, Chain, and Ownership System (PECOS),” explains Home Health & Hospice Medicare Administrative Contractor CGS on its recently revised webpage on claims reopenings. “While claims denied for this reason will appear...

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