Home Health & Hospice Week
Ward Off PECOS Edit Denials With MAC Tool's Help
If you're seeing claims denied because the ordering physician isn't in the PECOS system, you need to make sure you're checking the Ordering/Referring file before you bill. The first step is finding the PECOS file at all. HHH Medicare Administrative Contractor CGS says its "Provider Contact Center has received calls from providers with questions about how to access the Ordering/Referring data file." Reminder: "An ordering/referring physician for home health care must be enrolled in the Medicare program, and have an enrollment record in the Provider Enrollment, Chain, and Ownership System (PECOS). Providers should first verify that the physician's National Provider Identifier (NPI) is available on the list of ordering/referring physicians." Do this: Providers must go to data.CMS. gov, CGS instructs on its website. "From the Data.CMS.gov Web page, scroll down to find the 'Ordering and Referring' dataset. After selecting the 'Order and Referring' dataset, 'About this Dataset' will display the most recent attachment to download. Simply click on the link provided under the 'Attachments' heading [and] select Open or Save when asked (this will take a few minutes)." Resources: For step-by-step instructions on accessing the ordering/referring file, including screen shots, see www.cgsmedicare.com/hhh/pubs/news/2017/1117/cope5302.html. To access a CGS Quick Resource Tool on avoiding PECOS edit denials, go to www.cgsmedicare.com/hhh/education/materials/pdf/ord_ref_phys_checklist_hha.pdf.
Home Health & Hospice Week
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Ward Off PECOS Edit Denials With MAC Tool's Help
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