decisionhealth Newsletters, Part B News - 2010 Issue 7 (July)
CMS delays PECOS ordering/referring rule
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Article Overview
This news item explains a CMS delay affecting Medicare claims that involve orders or referrals from providers and the Provider Enrollment, Chain and Ownership System (PECOS). It is relevant to billing staff, practice managers, and compliance personnel who track Medicare enrollment requirements, claim processing changes, and implementation timing under federal guidance. The article also notes CMS’s interim statements, the uncertainty around enforcement timing, and the mention of a contingency plan tied to the health reform law.
Why This Topic Matters
Organizations that bill Medicare needed to know whether claims could be rejected because an ordering or referring provider was not enrolled in PECOS. The article helps readers understand the timing uncertainty and why practices were being advised to review enrollment records despite the delay.
What You Will Learn
- How CMS communicated the delay in automatic claim rejections related to PECOS enrollment
- Why Medicare providers and billing teams were concerned about ordering and referring provider enrollment status
- What CMS said about reviewing the PECOS process and its interim contingency plan
- How implementation timing and enforcement uncertainty affected provider preparation
Who Should Read This
- Medical billers
- Coding professionals
- Practice managers
- Compliance staff
- Medicare providers
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