General Surgery Coding Alert - 2011 Issue 1
Enrollment: PECOS Ordering/Referring Edits Won't Start Until July, CMS Says
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Article Overview
This article explains two CMS implementation delays affecting Medicare providers: a postponement of ordering and referring enrollment edits tied to PECOS, and a separate shift in enforcement timing for the hospice and home health face-to-face encounter requirement. It is relevant for Part B practices, hospices, home health agencies, and billing staff that track Medicare contractor edits, enrollment status, and documentation readiness. The discussion also references CMS contractor communications and industry association responses about operational preparation.
Why This Topic Matters
The timing of CMS enforcement changes can affect claim processing, provider enrollment readiness, and documentation workflows. Readers who bill Medicare or manage compliance need to know what is changing, when it changes, and which provider groups must prepare.
Article Sections
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Background: PECOS ordering/referring edits
Explains the status of Medicare contractor edits related to ordering and referring provider enrollment information and the announced delay in denials.
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Part B reminder
Summarizes the Medicare Part B processing steps described for handling ordering and referring information before claims are denied.
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Act now
Notes the article’s emphasis on preparing provider enrollment records in advance of the delayed enforcement date.
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CMS Also Delays Hospices' Face-to-Face Requirement
Introduces the separate CMS delay affecting hospice and home care face-to-face encounter enforcement.
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Victory
Reports reactions from provider organizations and contractor communications about the revised enforcement timeline.
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Background
Provides general background on the face-to-face encounter requirement and the documentation expectations described in the article.
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Keep at it
Addresses ongoing preparation efforts during the delay period and the need for providers to continue implementation planning.
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Start now
Includes additional organizational guidance encouraging providers to begin meeting the requirement ahead of the enforcement date.
What You Will Learn
- How CMS delayed enforcement timing for Medicare ordering and referring edits
- What provider groups were affected by the PECOS-related changes
- How CMS shifted the timing of hospice and home health face-to-face encounter enforcement
- Which organizations commented on the implementation delays
- What kinds of compliance preparation providers were urged to continue
Who Should Read This
- Medicare billing staff
- Compliance officers
- Home health agencies
- Hospices
- Part B provider organizations
- Physician practices
- Revenue cycle professionals
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