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CMS Issues New Payer-only Occurrence Code for Untimely Face-to-face Encounters

Posted on Thursday, November 19, 2015 4:18 PM

On November 6, 2015, the Centers for Medicare and Medicaid Services issued CR9385 (PDF), “Processing Hospice Denials When Face-to-Face Encounter is Not Received Timely.” This Change Request will create a new payer-only occurrence code. The code will assist in processing medical review determinations that some hospice services have been denied because of an untimely face-to-face encounter. Also, this Change Request contains no new policy. It does, however, improve the implementation of existing policy per CMS.  The effective date is April 1, 2016 for claims medically reviewed on or after this date. There is an implementation date of April 4, 2016.

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