RESOLVED: Hospice Certifying Physician Claim Edit, Reason Code 17729

Published 08/19/2024

RESOLVED: Hospice Certifying Physician Claim Edit, Reason Code 17729

Current Status

Date

 

Resolved August 19, 2024     Status: The actions in the July 23, 2024, update are completed. As of this update, most claims are reprocessed and finalized. 

Provider Action: The adjustment types of bills are 81I or 82I. These bill types will show on Remittance Advices when processed.

Claims that correctly rejected for reason code 17729 will reject again. For more information about how the edit works, please see Reason Code 17729

An adjustment should be submitted (as directed in the above linked article for reason code 17729) when an input error (e.g., incorrect NPI, incorrect name spelling) is being corrected or the physician’s PECOS record has been updated.

Update July 23, 2024

Status: Our research found that physicians were missing from or had incorrect records in the Hospice PECOS Physician File, which is used for this edit. The file issues were corrected on July 16, 2024, and claims received since should not reject with reason code 17729 in error.

Within 30 days of this update, the Medicare Administrative Contractors (MACs) will begin the reprocessing of all claims with the following criteria:

  • Rejected with reason code 17729 
     
  • Types of Bill 081x or 082x 
     
  • Claims with 'FROM' dates on or after 6/03/2024

Claims that correctly rejected for 17729 should reject again. For more information about how the edit works, please see Reason Code 17729.

Provider Action: No provider action is needed. Hospices should allow the MACs to adjust the claims to prevent any additional issues.

Hospices that have adjusted or started adjusting these claims may cause them to be missed in the MAC adjustments. Claims adjusted by the hospices will not be included in the MACs’ adjustments. 

Open

July 9, 2024

Status: Palmetto GBA and CMS are researching the issue. 

Provider Action: No provider action is needed.

 

For more information about how the edit works, please review Reason Code 17729.

Issue Description

Some claims have edited for Reason Code 17729 incorrectly when the certifying physician entered in the Attending field on the claim that matches the PECOS Enrolled Physicians File and the dates do fall within the physician's effective/termination dates.

 

Effective June 3, 2024, (delayed from May 1, 2024) for claim "From" dates on or after this date, CMS implemented edits to enforce a new rule that would deny hospice claims if the certifying physician entered in the Attending field on the claim is not in the Provider Enrollment Chain and Ownership System (PECOS) as an enrolled or opted-out physician. The hospice certifying physician need to be enrolled/opted-out at the time they make the certification or recertification of hospice care for a patient.


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