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Home Health & Hospice Week

Enrollment:

PECOS Deadline Sparks Industry Uproar

Published on Wed Jun 02, 2010

Implementation date confusion for the referring physician requirement is widespread. You'll risk non-payment and even False Claims Act liability if you submit claims without a PECOS-enrolled physician's NPI starting July 6. The Centers for Medicare & Medicaid Services' instructions on the new Medicare Provider  Enrollment Chain and Ownership System (PECOS) have been conflicting and vague. But it appears that home health agencies, durable medical equipment suppliers, and other Part B providers must include the referring physician's National Provider Identifier (NPI) on Medicare claims and the physician must have an approved record in the PECOS system. If not: Claims that don't have a referring physician's NPI in the PECOS record by July 6 are not eligible for payment. Where it gets confusing: CMS doesn't have the claims system edits ready for the new PECOS requirement. In an April transmittal, the agency said it planned to start informational PECOS edits for HHAs [...]
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