Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

New Medicare Specialty Code for Hospitalists

Physicians practicing as hospitalists will soon be able to self-designate with Medicare using the new specialty code C6 when they enroll or update their enrollment.

According to a recent MLN Matters, the change will go into effect April 1, 2017, and will be implemented on April 3, 2017. The new code can be selected on the Medicare enrollment application (CMS-855I or CMS-855O) or in the Internet-based Provider Enrollment, Chain and Ownership System (PECOS). According to Medicare Administrative Contractor WPS-GHA, which administers Parts A and B Medicare for Indiana and Michigan, the C6 Hospitalist code will be available in PECOS in January 2017, before it is an available option on the CMS 855I application form.

In a March 2016 article in The Hospitalist, Ron Greeno, MD, MHM, chair of the Society of Hospital Medicine’s Public Policy Committee, encouraged hospitalists to use the new code because it will be critical to ensure hospitalists are reimbursed and evaluated fairly in quality-based payment models.

“Under the current code structure, hospitalists are missing opportunities to be rewarded and may be penalized unnecessarily because they are required to identify with internal medicine, family medicine, or another specialty that most closely resembles their daily practice,” Greeno said. “What current measures do not account for is that hospitalists’ patients are inherently more complex than those seen by practitioners in these other—most often outpatient—specialties.”

In addition to its obvious use for enrollment, the C6 code also will be used as a valid specialty for the following edits:

  • Ordering/certifying Part B clinical laboratory and imaging, durable medical equipment (DME), and Part A home health agency (HHA) claims
  • Critical Access Hospital (CAH) Method II Attending and Rendering claims
  • Attending, operating, or other physician or non-physician practitioner listed on CAH claims.

For more information about the new C6 Hospitalist specialty code, review the MLN Matters MM 9716.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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