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Posts Tagged ‘referring provider’

CMS Delays PECOS Phase II Implementation Date

In Uncategorized on March 30, 2011 at 3:11 pm

CMS has recently issued a statement that it will NOT implement Phase 2 of PECOS on July 5th, as was originally published (point of reference:  during Phase I, which is currently underway, claims will have an appended warning when the ordering/referring proivider is not enrolled in PECOS; during Phase 2, which has yet to begin, all claims processed with an ordering/referring provider who is not enrolled in PECOS will be denied…  for more information on what PECOS is, see post published June 8, 2010):

“It has come to CMS’ attention that there was an editorial oversight in the OIG Compendium of Unimplemented Recommendations (March 2011 Edition). The OIG report states that the CMS will delay the implementation of Phase 2 of Change Request (CR) 6417 and CR until Tuesday, July 5, 2011.  This is incorrect. 

 CMS has not yet determined when it will begin to apply the ordering/referring provider claim edit to ordering/referring providers that do not have a record in the Provider Enrollment, Chain, and Ownership System (PECOS).  As previously stated, CMS will give providers ample notice before the ordering/referring provider claim edit is applied.  Recent revisions to CRs #6417 and #6421 require MACs to delay rejecting claims until receiving further direction from CMS.”  (emphasis added)

So, the net result is that parties to whom patients are ordered/refered will continue to receive EOB warnings regarding the PECOS status of the referring provider, but will be paid.  For now. 

When will this change?  I have no idea, so it would be advisable for all providers who have not enrolled in PECOS to date to do so as soon as practicable.  Anyone needing assistance in a) checking to see whether they are currently enrolled in PECOS, or b) enrolling in PECOS can contact M.E.D.I.C., Inc. (lsneathern@medicbilling.com) — we are happy to assist! 

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