PECOS System: PECOS Rejections Are Live--Follow These 8 Steps to Reduce Yours

Why This Topic Matters

PECOS-related claim edits can affect whether Medicare claims process or are rejected, so billing staff and providers need to understand the enrollment and claim-submission requirements discussed in the article.

Article Sections

1. Background and rollout of PECOS edits

   Introduces the implementation timing and the Medicare claims environment affected by the edits. It frames the article’s focus on ordering and referring provider information in Part B claims.

2. Who is affected

   Explains which categories of ordering and referring practitioners are included in the discussion. It also addresses the general Medicare-covered services and items that fall within scope.

3. Include incident to and x-ray orders in the rule

   Describes the broad service categories mentioned as part of the Medicare guidance referenced in the article. It notes that multiple imaging and related service types are discussed.

4. Know where to place the NPI

   Covers claim-form reporting location guidance for paper claims. It focuses on the submission field discussed for ordering or referring provider information.

5. Don’t add credentials

   Discusses formatting considerations for reporting provider names on claims. It addresses general name-entry cautions for paper and electronic submissions.

6. Make 'Caps Lock' your friend

   Addresses character-case formatting for electronic claim submission. It explains the general data-matching issue described in the article.

7. Don’t rely on ABNs

   Discusses the relationship between denied claims and beneficiary liability in the scenario described. It also references Medicare guidance on when an ABN is not appropriate.

8. Make sure you are in PECOS

   Encourages practices to confirm their own enrollment records in the PECOS system. It refers to checking internal enrollment status and seeking assistance when records are missing.

9. Bookmark the list

   Points readers to the Medicare ordering and referring provider lookup resource. It emphasizes verifying eligible ordering and referring practitioners and current enrollment records.