Don't be too quick to blame PECOS for all the informational messages you receive about claims lacking valid physician NPIs. Background:
Failure to enroll in PECOS is the number-one reason for the informational messages being issued, with 79 percent of claims with such messages being due to PECOS, CMS confirms in a new fact sheet about Medicare enrollment guidelines for ordering and referring providers.
But that's not the only reason. About "11 percent of informational messages are generated for organizational NPIs," CMS reveals in the fact sheet. "Orders must be written by eligible individual physicians or non-physician practitioners. Organizations are not eligible to order and refer.
Tip:
"Some eligible professionals have both a Type 1 (individual) and Type 2 (organizational) NPI," CMS explains. "You must use a Type 1 NPI for ordering and referring."And "10 percent of the informational messages are generated for individual providers who are of a specialty that is not eligible to order and refer," CMS adds. Only Doctors of Medicine or Osteopathy and Doctors of Podiatric Medicine may order or refer, the fact sheet says.
The fact sheet is at www.cms.gov/MLNProducts/downloads/MedEnroll_OrderReferProv_FactSheet_ICN906223.pdf. CMS has not yet set a date for the PECOS stage 2 edits to take effect.