Home Health & Hospice Week
PECOS Denial Edits To Hit In January
Often-delayed edits checking for referring physicians’ NPI and PECOS record get a new start date.
As if rebasing cuts aren’t enough to damage your cash flow in the new year, CMS now has set Jan. 6 as the deadline for phase 2 of so-called PECOS edits that will check physicians’ information.
The Centers for Medicare & Medicaid Services "will instruct contractors to turn on Phase 2 denial edits on January 6, 2014," CMS says in a Nov. 6 e-mail message. "These edits will check ... claims for a valid individual National Provider Identifier (NPI) [for the ordering or referring physician] and deny the claim when this information is invalid," the agency explains. The edits will apply to home health agency claims, as well as those for DME, lab tests and imaging.
CMS delayed its latest PECOS edit deadline of May 1 back in April (see Eli’s HCW, Vol. XXII, No. 15).
Like with face-to-face physician encounter requirements, the PECOS edits will make HHAs’ reimbursement dependent on referring physicians’ actions. Experts predict that agencies will have to turn down referrals from non-compliant docs, among other coping strategies. For tips on dealing with the edits and minimizing denials, see Eli’s HCW, Vol. XXII, No. 9.
Note: For more information on the edits, see a future issue of Eli’s Home Care Week.
Home Health & Hospice Week
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