E/M Coding Alert - 2009 Issue 42
ENROLLMENT: All Ordering/Referring Providers Must Be in PECOS by April 5
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Article Overview
This article covers a Medicare enrollment update tied to the PECOS system and how it affects claims involving ordering and referring practitioners. It is relevant to billing staff, practice managers, and coding professionals who work with Medicare claims, provider enrollment, and referral-based services. The article discusses the timing of the change, the providers affected, the role of MAC claim edits, and the need to confirm enrollment status before submitting affected claims.
Why This Topic Matters
Practices need to know whether ordering or referring providers are properly enrolled so they can avoid avoidable Medicare claim denials when services depend on those providers' records.
What You Will Learn
- How the Medicare enrollment update relates to ordering and referring providers
- Which types of providers are broadly affected by the change
- How the timing of the update affects claim processing
- Why provider enrollment status matters for Medicare claims involving referrals or orders
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance staff
- Provider enrollment staff
- Medicare-participating practices
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