tci Part B Insider - 2013 Issue 14

Denial Management: Could You Afford to Have 1.85 Percent of Your Claims Denied?

Many practices still skirting PECOS regs, one MAC finds You have only a few weeks to get your act together for the next phase of referring physician edits, or you’ll face major reimbursement woes. Background: Back in 2009, CMSimplemented edits that can detect when claims contained an invalid ordering or referring provider. Under the edits, the ordering physician must have a valid National Provider Identifier (NPI) number and be enrolled in Medicare’s Internet-based Provider Enrollment, Chain, and Ownership System (PECOS). But the first phase of edits has been informational only, so claims still pay even if the...

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