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.

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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 the NPI as this standard. Covered entities under HIPAA are required by regulation to use NPIs to identify health care providers in HIPAA standard transactions.

Please click here to download this booklet.  NPI Booklet

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 spinal garment billed with one of the preceding codes is made primarily of nonelastic material (e.g., cotton or nylon) or has a rigid posterior panel, the supplier must add the CG modifier (policy criteria applied) to the code. If the CG or GY modifier is not used with one of the preceding HCPCS codes, it will be rejected/denied as incorrect coding.

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