3 steps to avoid claims rejections in case new PECOS rule hits July 6

Why This Topic Matters

If a practice bills Medicare for services ordered or referred by providers, outdated enrollment records can create avoidable claim rejections and payment delays. The article helps readers recognize the administrative checks needed before the rule’s effective date and understand why provider enrollment status matters for claims submission.

Article Sections

1. Preparing for PECOS-related claim rejections

   Introduces the CMS enrollment issue and explains why practices are being urged to review provider records before the effective date. It frames the article around avoiding claim denials tied to enrollment status.

2. Check the online list of eligible providers

   Discusses the CMS-published provider list used to verify enrollment status and mentions timing considerations for list updates. It also covers the need to review whether referring and ordering providers appear on the report.

3. Check the PECOS website

   Describes using the PECOS system to review provider information and confirm record accuracy. It also notes what to do when records are missing or incomplete.

4. Don't delay

   Emphasizes prompt follow-up when a provider is not found in PECOS and notes uncertainty around enforcement timing. The section highlights the importance of acting before claims are affected.

5. Background on the rule and enforcement timing

   Provides context from the health reform law and Federal Register rule that prompted the updated enforcement approach. It also references the earlier planned implementation date and related CMS commentary.

6. Note on controversy over July 6 enforcement

   Summarizes the uncertainty discussed in the article about whether CMS would begin rejecting claims on the stated date. It reflects the article’s discussion of agency communication and timing concerns.