decisionhealth Newsletters, Part B News - 2009 Issue 12 (December)
CMS delays new PECOS enrollment for ordering/referring providers
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Article Overview
This article covers a CMS timing change affecting Medicare enrollment records in PECOS for providers who order supplies or durable medical equipment, as well as those who refer patients to other Medicare providers or suppliers. It is relevant to billing, credentialing, and enrollment staff who need to track Medicare claims processing changes, enrollment status checks, and related submission options. The article also notes a separate enrollment revalidation issue for some providers and points readers to general CMS enrollment resources and a workshop announcement.
Why This Topic Matters
Organizations handling Medicare DME and referral-related claims need to know about enforcement timing, enrollment verification, and the broader impact on claim processing and provider credentialing workflows.
Article Sections
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PECOS enrollment enforcement delay
Discusses the postponed implementation date for CMS enforcement affecting providers tied to Medicare ordering and referral activity. Covers the general distinction between warning-only processing and later claim denial processing.
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Checking PECOS enrollment status
Explains the general ways providers or staff can verify whether an enrollment record exists in PECOS. Mentions CMS and Medicare contractor resources used for status confirmation.
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Revalidation wrinkle for older enrollment records
Notes an additional enrollment issue for certain ordering and referring providers whose revalidation history predates a specified time period. Describes the need to complete an enrollment submission through CMS systems or paper forms.
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Workshop notice
Includes a brief informational notice about a Medicare provider enrollment workshop and contact information for additional details.
What You Will Learn
- How this CMS announcement changes the timeline for PECOS-related enrollment enforcement
- Which provider groups are affected by the enrollment notice
- How enrollment status is generally checked within CMS processes
- What broad enrollment follow-up issue is mentioned for some older provider records
- What related educational resource is referenced for enrollment staff
Who Should Read This
- Medical coders
- Billing staff
- Credentialing staff
- Practice managers
- Durable medical equipment suppliers
- Medicare enrollment staff
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