RESOLVED: Hospice Certifying Physician Claim Edit, Reason Codes 17729 and 17730

Provider Action: Please see the claim physician billing information in the issue description of this article for proper physician, NP or PA serving as an attending (if applicable), for all claim submissions on or after November 18, 2024.  

If a claim was denied with Reason Code 17729 or 17730 and physician, NP or PA billing needs to be corrected, please adjust the denied claim. For more information on adjustment billing, see Reason Code 17729.

Adjustment of non-medical claim denials are allowed by Medicare systems, and providers shall initiate an adjusted claim through their electronic billing software (Direct Data Entry cannot be used). If your electronic billing software does not allow the adjustment to occur, please contact the vendor to have them update their software. 

During the week of November 11, 2024, the HHH MACs set Reason Codes 17729 and 17730 to return to provider (RTP) instead of denying. Those RTP claims can now be resubmitted. 

On October 7, 2024, additional implementation edits on hospice claims for hospice certifying physician.

Medicare enrollment requirements were implemented. Business Requirements (BRs) 13531.3, 13531.3.1 and 13531.4 will be implemented on November 18, 2024. The edits are to occur only If the incoming hospice claim contains occurrence code 27 and the date of certification.The editing is occurring without the claims containing occurrence code 27 and the date of certification.

Claim Physician Billing Information
For all claim submissions after November 18, 2024, enter physicians, nurse practitioners (NPs) or physician assistants (PAs) serving as an attending (if applicable) using the direction below.  

• Attending Physician Field
  • Enter the name and NPI of the attending physician designated by the patient
    • If there is not an attending physician designated by the patient, enter the hospice certifying/recertifying physician
    • The patient’s designated attending physician could be an independent physician, hospice physician, an NP or PA
      • When a NP or PA is serving as the attending, the processing system shall use the NPI submitted in the Referring Provider Field to verify the physician (medical director or physician member of the interdisciplinary group) has a PECOS enrollment
• Referring Provider Field
  • Enter the name and NPI of the hospice’s physician responsible for certifying patient’s terminal illness
    • When no attending is designated or the attending physician is also the certifying physician, only populate the attending physician field and leave this field blank