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October 29, 2019

Maryland Nurse Practitioners and Home Health Providers: What You Need to Know!

Currently, Medicare pays for home health services only if a physician certifies the beneficiary's eligibility for the home health benefit, not a nurse practitioner (NP). However Change Request (CR) 11330External PDF will enable all Medicare-enrolled NPs in Maryland to certify home health services for Medicare beneficiaries as part of the Maryland Total Cost of Care (TCOC) Model.

Effective for services provided on and after January 1, 2020, CGS will allow home health final claims (type of bill 032x) with an NP's name and National Provider Identifier (NPI) in the Attending Provider field (FISS Claim Page 03). The Fiscal Intermediary Standard System (FISS) will edit to ensure the NP's NPI is valid and that the NP is enrolled in Medicare and is in Medicare's Provider Enrollment, Change and Ownership System (PECOS).

The NP's NPI will also be allowed on professional claims containing HCPCS G0179, G0180, G0181 or G0182 which are submitted to the Maryland Medicare Administrative Contractor (MAC), Novitas Solutions, Inc.

Please make sure your billing staffs are aware of this change. For additional information, refer to the MLN Matters article, MM11330External PDF.

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