BALTIMORE – Coming off last week’s confusing Open Door Forum, HME News called Jim Bossenmeyer, director for the division of provider and supplier enrollment at CMS, for clarification on the Provider Enrollment, Chain and Ownership System (PECOS). For more information and the entire article please click here PECOS
CMS to providers: No PECOS grace period
BALTIMORE – CMS officials aren’t cutting HME providers any slack when it comes to complying with the July 6 deadline for the Provider Enrollment, Chain and Ownership System (PECOS). HME providers who take Medicare referrals on or after July 6 from physicians not enrolled in PECOS risk having those claims rejected, CMS officials stated during [...]
Hand-Finger Orthoses (L3923) – Use of CG Modifier
If a hand-finger garment is made primarily of elastic material, it must be billed with code A4466 (Garment, belt, sleeve or other covering elastic or similar stretchable material, any type, each) and not code L3923. Claims billed with code A4466 will be denied as noncovered, no benefit category. Effective for claims with dates of service [...]
PECOS Enrollment Delayed Until January 3, 2011
The delay in implementing Phase 2 will give physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers sufficient time to enroll in Medicare or take the action necessary to establish a current enrollment record in Medicare prior to Phase 2 implementation. [...]
The National Provider Identifier (NPI) – What You Need to Know
This booklet was created to help you become more familiar with the National Provider Identifier (NPI). The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard, unique health identifier for each health care provider. The NPI Final Rule, published on January 23, 2004, established [...]
Update on Elastic Spinal Garments
Effective for claims with dates of service on or after April 1, 2009, if a spinal garment billed with one of the preceding HCPCS codes is made primarily of elastic material, the supplier must add the GY modifier to the code and the claim line will be denied as noncovered, no benefit category. If a [...]
Compliance Standards for Consignment Closets and Stock and Bill Arrangements
Transmittal 300, dated September 1, 2009 is being rescinded. CMS is rescinding this change request to consider other implementation dates. Please click here to see document Transmittal 300
The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum (ODF) February 17, 2010
During this call, CMS staff will discuss: • Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for physicians, non-physician practitioners and provider and supplier organizations • Provider and supplier reporting responsibilities • Medicare ordering and referring Issues • Revalidation efforts For more information please click here CMS Open Door Forum
MEDICARE ORDERING AND REFERRAL FILE
As stated in the CMS provider listserv messages that were sent last fall concerning CRs 6417 and 6421, CMS has made available in the Downloads section of this web site a file that contains the National Provider Identifier (NPI) and the name (last name, first name) of all physicians and non-physician practitioners who are of [...]
A Message of Interest to Physicians and Non-Physician Practitioners Regarding NPI and Enrollment Files
Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) [...]
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