| West Virginia Oncology Society |
During Phase 2 of the implementation of Change Requests 6417 and 6421 (April 5, 2010 and
thereafter) if the item or service you bill requires an ordering/referring provider and the
ordering/referring provider is not on the claim, the claim will not be paid. It will be rejected.
If the ordering/referring provider is on the claim, Medicare will verify that the
ordering/referring provider is in the Provider Enrollment Chain of Ownership System (PECOS)
and eligible to order and refer. If the ordering/referring provider is not in PECOS, the carrier
or Part B Medicare administrative contractor (MAC) will search its claims system for the
ordering/referring provider.
If the ordering/referring provider is not in PECOS and is not in the claims system, the
claim will not be paid. It will be rejected. If the ordering/referring provider is in PECOS or the
claims system but is not of the specialty to order or refer, the claim will not be paid. It will be
rejected.
We strongly recommend that all physicians and nonphysician practitioners who order or refer
items/services review Medicare Learning Network Matters articles MM6417 and MM6421
released in 2009 concerning this implementation. The articles may be found on the Centers for
Medicare & Medicaid Services (CMS) Web site at http://www.cms.hhs.
gov/MLNMattersArticles/. Although CMS has delayed the implementation of Phase 2 until April
5, 2010, we continue to urge physicians and nonphysician practitioners who are enrolled in
Medicare but who have not updated their Medicare enrollment record since November 2003 to
update their enrollment record now.
CMS released a notice as a follow up to an Open Door Forum conducted November 17, 2009
that is helpful. The notice is titled, “Tuesday, November 17, 2009 Physicians ODF Follow Up
Notice” and may be found at this link in the downloads section http://www.cms.hhs.
gov/OpenDoorForums/23_ODF_PNAHP.asp.
Providers who order or refer may want to verify their enrollment in PECOS. They may do so
by accessing Internet-based PECOS at https://pecos.cms.hhs.gov/pecos/login.do.
thereafter) if the item or service you bill requires an ordering/referring provider and the
ordering/referring provider is not on the claim, the claim will not be paid. It will be rejected.
If the ordering/referring provider is on the claim, Medicare will verify that the
ordering/referring provider is in the Provider Enrollment Chain of Ownership System (PECOS)
and eligible to order and refer. If the ordering/referring provider is not in PECOS, the carrier
or Part B Medicare administrative contractor (MAC) will search its claims system for the
ordering/referring provider.
If the ordering/referring provider is not in PECOS and is not in the claims system, the
claim will not be paid. It will be rejected. If the ordering/referring provider is in PECOS or the
claims system but is not of the specialty to order or refer, the claim will not be paid. It will be
rejected.
We strongly recommend that all physicians and nonphysician practitioners who order or refer
items/services review Medicare Learning Network Matters articles MM6417 and MM6421
released in 2009 concerning this implementation. The articles may be found on the Centers for
Medicare & Medicaid Services (CMS) Web site at http://www.cms.hhs.
gov/MLNMattersArticles/. Although CMS has delayed the implementation of Phase 2 until April
5, 2010, we continue to urge physicians and nonphysician practitioners who are enrolled in
Medicare but who have not updated their Medicare enrollment record since November 2003 to
update their enrollment record now.
CMS released a notice as a follow up to an Open Door Forum conducted November 17, 2009
that is helpful. The notice is titled, “Tuesday, November 17, 2009 Physicians ODF Follow Up
Notice” and may be found at this link in the downloads section http://www.cms.hhs.
gov/OpenDoorForums/23_ODF_PNAHP.asp.
Providers who order or refer may want to verify their enrollment in PECOS. They may do so
by accessing Internet-based PECOS at https://pecos.cms.hhs.gov/pecos/login.do.
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