E/M Coding Alert - 2009 Issue 33
PHYSICIAN ORDERS/REFERRALS: Next Year, Medicare Will Deny Claims if Referring/ Ordering Doc Isn't in PECOS Or Claims System
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Article Overview
This Medicare billing article covers CMS changes affecting claims based on physician orders and referrals, including the role of PECOS, the MAC claims system, and NPI tracking. It is intended for practices that receive ordered or referred services and need to understand the general compliance changes, provider lookup resources, and the operational impact of the new screening process.
Why This Topic Matters
It matters because practices that rely on orders or referrals may face claim processing problems if provider enrollment information is not current. The article helps billing and compliance staff understand the broad change in Medicare claim review and why maintaining accurate physician identifiers is important.
What You Will Learn
- How Medicare claim processing is changing for ordered and referred services
- Why PECOS and the MAC claims system are relevant to provider screening
- What kinds of billing workflows may need stronger NPI tracking
- How CMS-related lookup resources support provider verification
- Which practice types may be most affected by referral-dependent services
Who Should Read This
- Medical billers
- Coding professionals
- Compliance staff
- Practice managers
- Revenue cycle staff
- Physician office administrators
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