ED Coding & Reimbursement Alert - 2011 Issue 33
Mac Spotlight: Enrolled in PECOS Last Year? You'll Still Have to Revalidate, This MAC Says
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Article Overview
This Medicare coding and enrollment update explains contractor guidance discussed on an Ask the Contractor teleconference. It focuses on PECOS enrollment and revalidation timing, reporting specialty changes for separate-specialty patient encounters, and a contractor response to concerns about retroactive CCI edit changes during RAC audit activity. The article is relevant to physician practices, billing staff, compliance teams, and coders who manage Medicare enrollment and claim review issues.
Why This Topic Matters
It helps practices understand Medicare enrollment maintenance expectations, avoid specialty-related claim problems, and stay aware of audit and edit-update issues that can affect claim outcomes and appeals.
Article Sections
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PECOS Revalidation Guidance
Discusses Medicare enrollment and revalidation messaging shared through a MAC teleconference. The section addresses timing, carrier notifications, and provider file review at a broad level.
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Separate-Specialty New Patient Reporting
Covers guidance related to specialty reporting and new patient billing when a provider practices in a distinct medical specialty. The section also notes the role of Medicare specialty classification.
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RAC Appeals and Retroactive CCI Edit Changes
Summarizes a contractor response to concerns about audit findings tied to changing Correct Coding Initiative edits. The section describes the broader issue of retrospective audit review and referral to the audit contractor.
What You Will Learn
- How Medicare revalidation discussions affect practices enrolled in PECOS
- What broad enrollment and specialty-reporting issues can affect Medicare claim processing
- How contractor guidance addresses concerns about retrospective audit reviews and edit changes
- Which organizations and contractor processes are involved in the discussion
Who Should Read This
- Physician practices
- Medical billers
- Certified coders
- Compliance staff
- Practice managers
- Healthcare administrators
Codes Discussed
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