Ordering/Referring Physician PECOS Mandate Delayed

As reported previously, effective April 5, 2010, Medicare Administrative Contractors (MACs) were slated to begin denying claims for ordering/referring physician claims where the name and NPI number of the physician listed in box 17 and 17a were not in the Provider Enrollment Chain and Ownership Supply (PECOS) system or the claims system of the MAC.

CMS is extending this deadline to enroll in the PECOS system until January 3, 2011.

CMS indicates that it will send a reminder to all physicians to enroll in the new PECOS system if they enrolled in Medicare more than six years ago.

To read more, go to:
http://www.cms.hhs.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp#TopOfPage

As more information becomes available, we will keep you apprised.

For guidance on this issue, contact us through the Third Party Insurance Help Program.

James A. McNally, CPC
Health Care Consultant Services