Medicare Compliance & Reimbursement
CMS Delays PECOS Denial Deadline
Good news: You won't face claims denials in January due to PECOS edits, thanks to an updated CMS directive on the issue. Background: Currently, if you submit claims for services or items ordered/referred and the ordering or referring physician's information is not in the MAC's claims system or in PECOS, your practice will get an informational message letting you know that the practitioner's information is missing from the system. It was previously announced that CMS would start denying these claims on Jan. 3, but that is no longer the case. On Nov. 29, CMS distributed an email that the agency referred to as an "Important Update on PECOS and Ordering/Referring," in which the agency noted, "While there are some rumors that the edits will be turned on in January, we want to reiterate that CMS has not announced any date (January 3 or otherwise) as to when ordering/ referring edits will be turned on." Backtrack: Despite CMS's denial that it ever said claim rejections would start on Jan. 3, MLN Matters article SE1011, which CMS distributed earlier this year, had stated, "Beginning January 3, 2011, Medicare will reject Part B claims that fail the Ordering/Referring Provider edits." Final resolution: On Nov. 29, CMS revised MLN Matters article SE1011 to clarify the topic, adding the statement, "The automated edits will not be turned on effective January 3, 2011." The agency is working to resolve enrollment backlogs, and until those issues are corrected, the claims will not be rejected. Act now: Even though CMS won't reject your claims on Jan. 3, you should still take this time to ensure that you and your ordering/referring providers are in PECOS as soon as possible, just in case the MAC edits become a reality. (Editor's note: To read MLN Matters article SE1011, visit www.cms.gov/MLNMattersArticles/downloads/SE1011.pdf.)
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CMS Delays PECOS Denial Deadline
Good news: You won't face claims denials in January due to PECOS edits, thanks to [...]
