CMS Announces Temporary Delay in PECOS Implementation

CMS issued the following message this morning announcing 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. 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 deny.

  • 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 you of 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. The complete message can be read here. Implementation of the Phase 2 ordering and referring denial edits is being delayed. Additional information is available in “Temporary Delay in Implementing Ordering and Referring Denial Edits.”

For more information about PECOS including resources to get prepared for implementation, visit the HCAF Resources for Medicare Providers webpage by clicking here, then select “PECOS”.

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