CMS Sets July 5, 2011 Target for Implementation of PECOS Ordering/Referring Edits

Written by Reed Tinsley | December 18, 2010

 

CMS has issued a new transmittal to update its timeline for implementing claims edits that will deny claims for services ordered or referred by a physician or other eligible professional who does not have an approved file in PECOS. The transmittal confirms an earlier CMS list-serve announcement that CMS will not implement the edits (that could cause nonpayment for services ordered by practitioners not in PECOS) on January 3, 2011. Instead, CMS has established a new "implementation placeholder date" of July 5, 2011, which CMS notes will "give CMS more flexibility to determine the appropriate date for nonpayment of claims that fail the ordering/referring provider edits."

You need to make sure all of your providers are enrolled in they PECOS system.

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.

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