CMS Announces Delay in PECOS Edits
April 25, 2013 03:36 PM
CMS issued the following message on April 25announcing the delay of PECOS edits that would result in denial of home health claims when the ordering/referring physician is not enrolled in PECOS:
Temporary Delay in Implementing Ordering and Referring Denial Edits
Due to technical issues, implementation of the Phase 2 ordering and referring denial edits is being delayed.
NAHC will provide more details as they become available.
These edits would have checked the following claims for an approved or validly opted-out physician or non-physician who is an eligible specialty type with a valid individual National Provider Identifier (NPI).
If either of these were missing or incorrect, claims would be denied:
Medicare Part B claims from laboratories, imaging centers and Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider; and
Part A Home Health Agency (HHA) claims that require an attending physician provider.
CMS will advise interested organizations about the new implementation date in the near future. In the interim, informational messages will continue to be sent for those claims that would have been denied had the edits been in place.
Recent NAHC Report articles have reported extensively on the pending PECOS edits which have now been delayed. NAHC had raised several issues of concern to home health providers regarding the edits with CMS.
Past NAHC Report articles on PECOS edits can be found here, here, and here.
The complete message can be read here.
Additional information is available here.