tci Medicare Compliance & Reimbursement - 2011 Issue 19
Mac Spotlight: Enrolled in PECOS Last Year? You'll Still Have to Revalidate, This MAC Says
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Article Overview
This Medicare contractor update explains how PECOS enrollment revalidation is being handled, including the carrier communication process and the difference between providers newly joining PECOS and those needing to revalidate existing enrollment information. It also covers a separate specialty billing question involving cardiac electrophysiology and a discussion of how retroactive CCI edit changes can affect RAC audit disputes. The article is aimed at practices, billing staff, and compliance teams that manage Medicare enrollment and claims issues.
Why This Topic Matters
Practices may need to monitor Medicare enrollment communications, maintain accurate PECOS information, and understand how specialty designation can affect claim processing. The article also highlights how changing edit logic and audit activity can create confusion for billing teams.
Article Sections
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PECOS Revalidation Process
Discussion of Medicare enrollment revalidation timing, carrier notification, and what practices are being asked to review when contacted.
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Know How to Report Separate-Specialty New Patients
A billing question about new patient reporting when care is provided by a physician in a distinct Medicare-recognized specialty within a practice.
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MAC Fails to Shed Light on RAC Appeals
An overview of a RAC audit dispute involving retroactive edits and the limits of the MAC's role in resolving the appeal issue.
What You Will Learn
- How Medicare revalidation communications are being managed for providers in PECOS and those not yet enrolled.
- Why specialty designation matters when reporting new patient services within a practice.
- How retroactive edit changes can complicate audit and appeal discussions.
- Who to contact when a dispute falls outside the MAC's control.
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance staff
- Physician offices
- Medicare-enrolled providers
Codes Discussed
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