The Centers for Medicare & Medicaid Services (CMS) previously announced that, beginning January 3, 2011, if certain Part B billed items and services require an ordering/referring provider and the ordering/referring provider is not in the claim, is not of a profession that is permitted to order/refer, or does not have an enrollment record in the Medicare Provider Enrollment, Chain and Ownership System (PECOS), the claim will not be paid. The automated edits will not be turned on effective January 3, 2011.
CMS has stated that it is working diligently to resolve their enrollment backlogs and other system issues and will provide ample advanced notice to the provider and beneficiary communities before CMS begins any automatic nonpayment actions.
CMS urged physicians or other eligible professionals not currently enrolled in PECOS to enroll sooner rather than later, and outlined three ways that providers can verify their enrollment record in their system:
- Check the Ordering Referring Report on the CMS Web site;
- Use Internet-based PECOS to look for your PECOS enrollment record; and
- Contact your Medicare contractor and ask whether you have an enrollment record in PECOS.