We understand that if a physician does not have an enrollment or opt-out record
in PECOS, Medicare will not cover the services. Is there a mechanism for
billing the beneficiary, since we are instructed not to use the Home Health
Advance Beneficiary Notice?
A:
If a
beneficiary receives services that are ordered/certified by a physician who is
not enrolled in Medicare and the physician refuses to enroll, the beneficiary
cannot be billed for those services. The agency can avoid these circumstances
by asking the physician if they are enrolled, and obtaining verification of
enrollment, before the services are provided.
