Home Health & Hospice Week
Docs' PECOS Status May Doom Your Claim
Don’t bother appealing claims if they encounter denials for certain PECOS errors, HHH Medicare Administrative Contractor Palmetto GBA says on its website.
If your referring/ordering physician does not have a PECOS record, the denial is “not reversible,” Palmetto says. The same goes if the doc isn’t of a specialty eligible to order home health, or “the PECOS physician file has a termination date present and it is equal to or less than the claim from date,” Palmetto says.
In those three scenarios, “the claim is not payable,” Palmetto stresses. “Do not submit an adjustment or appeal.”
More information about PECOS denials and appeals are on Palmetto’s website. Email editor Rebecca Johnson at rebeccaj@eliresearch.com for a free link.
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