Home Health & Hospice Week
System Incorrectly Denies Claims For Nonexistent Physician PECOS Problems
Pay attention: Some PECOS edit de-nials may not be valid.
“Some home health claims and adjustments may have been denied inappropriately with reason code 37236 or 37237,” HHH Medicare Administra-tive Contractor CGS says on its website. “Some home health claims and adjustments are being submitted with ordering/referring physician information that matches the Medicare Ordering and Re-ferring File on the Centers for Medicare & Medi-caid Services (CMS) website. However, the provider file in the Fiscal Intermediary Standard System (FISS) indicates that the physician’s information is not on the Provider Enrollment, Chain and Ownership Sys-tem (PECOS) file.”
The MAC has referred the problem for research. “CGS will provide additional information as soon as it becomes available,” it pledges.
Home Health & Hospice Week
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System Incorrectly Denies Claims For Nonexistent Physician PECOS Problems
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