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
Category: Medicare
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 last week’s Open Door Forum. For more information, please click here PECOS Grace Period
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 on or after July 1, 2010, if an L3923 orthosis has a rigid plastic or metal component, the supplier must add the CG modifier (policy criteria applied) to the code. Claims for L3923 billed without a CG modifier will be rejected as incorrect coding.
Please click here for more information Hand-Finger Orthosis Code Info
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.
Please click here for more information PECOS
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
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