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Practice Management Alert

Payer Updates:

CMS Says It May Not Deny PECOS Claims Starting in January

Published on Mon Nov 15, 2010

Plus, Minnesota BCBS tests new incentive-based payment with four hospital systems.You may -- or may not -- face claims denials in January due to PECOS edits, depending on which CMS announcement you read.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 believed that CMS would start denying these claims on Jan. 3, but now that's up in the air.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 [...]
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