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

Published 08/29/2019

Palmetto GBA is seeing an increase in Comprehensive Error Rate Testing (CERT) contractor-related denials of service due to improper billing of 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/re-certification 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/re-certification, then only the “Attending” provider name/NPI is required to be entered on the claim.

Please refer to the Centers of Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication, Number 100-04 (Medicare Claims Processing Manual), Chapter 10, Section 40.2 (PDF, 749 KB) for further information about the above requirement.


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