Medicare Compliance & Reimbursement

But if they are accepted into PECOS to order/refer only, they can't use that NPI to bill Medicare directly. CMS is offering conditional "ordering/referring only" PECOS enrollment status -- for a select few. If your physician performs a service as the result of an order or referral, your claim must include the ordering or referring practitioner's National Provider Identifier (NPI), and that number must be in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) or the payer's computer system. But in some cases, the ordering or referring physician is not in PECOS because he works for a VA hospital, the Dept. of Defense (DOD), or a Public Health System (PHS). Currently, if you submit claims for services or items ordered/referred and the ordering or referring physician's information is not in the Medicare Area Contractor's (MAC's) claims system or in PECOS, your practice will get an informational message letting you know that [...]