New Medicare claim denials begin May 1

Effective May 1, 2013, the Centers for Medicare and Medicaid Services (CMS) will turn on the Phase 2 denial edits. This means that Medicare will deny claims for services or supplies that require an ordering/referring physician to be identified in the Medicare enrollment system, PECOS. If that physician is not identified, is not in Medicare's enrollment records, or is not of a specialty type that may order/refer the service/item being billed, he/she will not be paid.

As such, you are encouraged to enroll online, not by paper. Online is much faster. Make sure and read the directions thoroughly. There is an Electronic Fund Transfer (EFT), Form 588, that has to be mailed in by paper with an original signature, but you have to establish a bank account first. If you are receiving Medicare checks in the mail, this will stop and the funds will be electronically sent to the bank. Waiting too long to begin this process could mean that your enrollment application may not be processed prior to the May 1, 2013, implementation date. If this happens, your claims will be denied.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.