In response to advocacy efforts, the Centers for Medicare & Medicaid Services (CMS) recently postponed a claims edit that would have resulted in denial of payment for claims if the ordering or referring provider listed on the claim is not enrolled in Medicare’s web-based “PECOS” (Provider Enrollment, Chain and Ownership System) provider enrollment database. Previously, Medicare planned to begin denying such claims on January 3, 2011. Medicare still plans to enforce the claims edit at a future date that has not yet been announced. In the meantime, physicians will continue receiving notifications on EOBs if the ordering or referring provider listed on claims is not enrolled in PECOS. Those claims will continue to be paid beyond January 3, however.
Physicians who are not currently enrolled in PECOS should begin the enrollment process as soon as possible. Physicians are also reminded that PECOS enrollment is also required to receive federal Medicare incentives, such as those for electronic prescribing, PQRI, and for EHR implementation.