Part B Insider (Multispecialty) Coding Alert

Published on Mon Feb 28, 2011 PDF

Your Medicare contractor may not be instituting ordering/referring PECOS edits this July, CMS says.

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. But once CMS institutes Phase 2 of the program, you'll get a denial instead.

In December, CMS announced via Transmittal 825 that the "placeholder future implementation date" of Phase 2 would be July 5, 2011. In addition, earlier this month, the OIG printed that July 5 implementation date in its Compendium of Unimplemented Recommendations.

However, a March 21 CMS announcement states that the OIG was incorrect when it said that Phase 2 begins in July, because "CMS has not yet determined when it will begin to apply the ordering/referring provider claim edit." Keep an eye on the Insider as CMS's calendar firms up on this issue.