Articles and Blogs

pecos

Location Matters: Get It Right or Don’t Get Paid

[03/06/19]

Posted on March 6, 2019 in Health Law News

Published by: Hall Render

Location, location, location – this will be the focus of a Medicare hospital claims processing requirement. Starting in April 2019, CMS will activate billing edits that will Return to Provider (“RTP”) any hospital UB-04 claims that identify a service location that is not an exact match to a Medicare enrolled location identified in Provider... READ MORE

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Claims Denials Start April 1: What You Should Know About CMS’s New Preclusion List

[02/15/19]

Posted on February 15, 2019 in Health Law News

Published by: Hall Render

Beginning April 1, 2019, Medicare Part C and D plans, PACE organizations and 1876 cost contract plans (“Plans”) will be required to deny payment for services rendered or prescriptions ordered by any provider on the new Centers for Medicare & Medicaid Services (“CMS”) Preclusion List. The Preclusion List, which was first made available to... READ MORE

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Internet-Based PECOS Improvements Increase Access to Information

[08/14/12]

Posted on August 14, 2012 in Long-Term Care, Home Health & Hospice

Written by: Selby, Todd J.

The Centers for Medicare & Medicaid Services (CMS) implemented changes to Internet-based PECOS to allow providers easier access to information. The following enhancements are now available: READ MORE

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Competitive Bidding Program Round 1 Recompete is Just Around the Corner

[07/12/12]

Posted on July 12, 2012 in Long-Term Care, Home Health & Hospice

Written by: Kendra Conover

The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) Competitive Bidding Program Round 1 Recompete will begin later this year.  Below is the schedule the Centers for Medicare & Medicaid Services (“CMS”) has announced so far: READ MORE

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Update to Scope of DMEPOS Claims Editing for Referring/Ordering Provider

[11/11/11]

Posted on November 11, 2011 in Long-Term Care, Home Health & Hospice

Written by: Kendra Conover

Change Request (CR) 6421 was recently revised to remove chiropractors from the list of providers who may order or refer for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS).  All other information in the CR remained the same.  As you will recall, in CR 6421, the Centers for Medicare & Medicaid Services (CMS) started the expansion of claim editing to... READ MORE

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National Supplier Clearinghouse Acknowledges Certain Issues in PECOS Conversion

[11/04/11]

Posted on November 4, 2011 in Long-Term Care, Home Health & Hospice

Written by: Kendra Conover

The National Supplier Clearinghouse (“NSC”) has recently indicated it is aware that numerous Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) suppliers are having issues with viewing and/or submitting revalidation information through the web-based Provider Enrollment Chain Ownership System (“PECOS”). NSC has indicated that the majority of these issues are due to information discrepancies... READ MORE

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Medicare Providers and Suppliers Must Begin Enrollment Revalidations

[08/10/11]

Posted on August 10, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

As of March 2011, the Centers for Medicare & Medicaid Services (CMS) implemented new screening criteria in the Medicare provider/supplier enrollment process.  Newly enrolling and revalidating providers and suppliers are placed in one of three categories – limited, moderate, or high – each representing the level of risk to the Medicare program for that... READ MORE

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