Outpatient Facility Coding Alert - 2011 Issue 12
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Article Overview
This article covers a Medicare program update from CMS about when ordering and referring provider claim edits may take effect and how those edits relate to PECOS and the MAC claims system. It is aimed at billing staff, compliance teams, and providers who track Medicare claim-processing changes and implementation timing. The piece summarizes announcements from CMS and mentions the OIG’s discussion of the same implementation date.
Why This Topic Matters
Organizations that bill Medicare need to monitor claim-edit implementation dates so they can anticipate potential denials and system impacts tied to provider enrollment and referral data.
What You Will Learn
- How CMS described the status of ordering and referring provider claim edits
- How the timing of Phase 2 was discussed in CMS and OIG communications
- Why PECOS and MAC claims-system data are relevant to these Medicare edits
- What this update means for monitoring future Medicare billing changes
Who Should Read This
- Medical billers
- Coding professionals
- Revenue cycle staff
- Compliance staff
- Medicare providers
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