CMS Issues Conflicting Deadlines on Ordering/Referring PECOS Enrollment Mandate

In February, CMS announced a new deadline of January 3, 2011 for the implementation of phase 2 of the enrollment requirements for getting ordering, referring providers into the PECOS system. 

However, according to the Federal Register published May 5, 2010, the date has been moved up to July 6, 2010. The change is in interim status, with a 30 day comment rule, so we will not know for certain that July 6 is the new effective date until early June.   

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

Claims with an ordering/referring physician name and NPI number on a claim require that the ordering/referring physician be enrolled in the Provider Enrollment, Chain and Ownership System (PECOS). Without this, claims will be denied.

To determine if you are already in the system, review the file found at:

http://www.cms.hhs.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp. 

If you are on this list, no action is necessary.

If you are not on this list, you must enroll through the PECOS system.

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James A. McNally, CPC

Health Care Consultant Services