Were you aware that as of January 6, 2014 as part of the Affordable Care Act, Medicare will deny claims payments if the referring doctor is not listed in the PECOS system? In 2010 Congress passed a law requiring physicians who order or refer testing for Medicare patients to enroll in Medicare and use their NPI numbers as the referring provider number on those claims.
If you wish to verify that your referring providers are in the PECOS system go to http://www.oandp.com/pecos/ enter the providers NPI or name.
The CMS final rule on this affects Imaging or lab services, home health agencies and DME suppliers.
Payment for claims for any of these providers will be denied if the referring provider is not listed in PECOS. Unfortunately this does seem like they are penalizing the WRONG provider! If this should happen for any of your claims contact that provider and give them the following link to the Medicare Provider Enrollment, Chain, and Ownership System (PECOS), https://pecos.cms.hhs.gov/pecos/login.do , where they can learn about initial enrollment and get enrolled!
As always, give us a call if we can help you with any of your billing needs at 1.877.666.5279 and “Take Advantage”