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CMS Moves to Edit Claims Against “PECOS”

(October 26, 2009)

Take Steps Using Detailed Information Communicated by CMS

Callers questioned and expressed frustrations over the Centers for Medicare & Medicaid Services (CMS) plans to deny suppliers’ claims starting January 4, 2010 which contain ordering or referring practitioners, e.g. physicians, not found on a Medicare database called PECOS (Medicare's Provider Enrollment, Chain and Ownership System.) This occurred on CMS’s October 21 Open Door Forum where the questions and comments on the subject were opened by NHIA which told CMS that home infusion pharmacies and other suppliers are receiving many of these warnings and are concerned about the potential for rejection in January.

Beginning October 5, home infusion pharmacies and other Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers began receiving many warning messages from electronic claims they submit to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) that ordering or referring physicians are not authorized.

NHIA is working with its members and the DME MAC Advisory Councils on the matter to better understand the details of this PECOS implementation and notify CMS of our concerns.

  • NHIA members: click here to learn more for taking steps to handle this situation.