SEARCH PECOS DATABASE THE EASY WAY!
posted by The OPBS Team
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8:38 AM
OPBS News
July 1, 2010
June 8, 2010
PECOS Implementation Date Moved Up to July 6, 2010
The Centers for Medicare and Medicaid Services (CMS) has published a change to the date by which referring physicians must have active accounts in the Provider Enrollment Chain and Ownership System (PECOS), from January 3, 2011 back to July 6, 2010. According to Jim Bossenmeyer from CMS, the earlier implementation date is a requirement of provisions contained in the Patient Protection and Affordable Care Act (PPACA) passed earlier this year.
In order for a physician's or other qualified healthcare practitioner's referral or order to be considered valid for Medicare claim submission purposes, it must come from a provider with a current PECOS enrollment record.
Originally scheduled for implementation on January 4, 2010, the PECOS requirement has been delayed several times in order for CMS to develop proper system edits to properly enforce it. While Mr. Bossenmeyer stated in a May 26, 2010 CMS Open Door Forum that PECOS system edits may not be fully functional by July 6, CMS reserves the right to reprocess claims that should not have been paid due to an invalid referral once the edits are fully functional. This means that you may still get paid for claims with an invalid referral, however your DME MAC may come back later and request a refund.
The four DME MACs are continuing to generate warning notices when services are referred by physicians who do not have a current PECOS record. If you receive one of these notices, you need to first check that the provider information submitted on your claim included the provider's correct individual NPI number and name. The name must be in all capital letters and match what the physician entered in the NPI registry system. The referral physician's name on the claim information should not contain credentials (e.g. MD), titles, or punctuation, except for the hyphen in hyphenated names, and must not be a nickname (e.g. use Robert, not Bob).
In order for a physician's or other qualified healthcare practitioner's referral or order to be considered valid for Medicare claim submission purposes, it must come from a provider with a current PECOS enrollment record.
Originally scheduled for implementation on January 4, 2010, the PECOS requirement has been delayed several times in order for CMS to develop proper system edits to properly enforce it. While Mr. Bossenmeyer stated in a May 26, 2010 CMS Open Door Forum that PECOS system edits may not be fully functional by July 6, CMS reserves the right to reprocess claims that should not have been paid due to an invalid referral once the edits are fully functional. This means that you may still get paid for claims with an invalid referral, however your DME MAC may come back later and request a refund.
The four DME MACs are continuing to generate warning notices when services are referred by physicians who do not have a current PECOS record. If you receive one of these notices, you need to first check that the provider information submitted on your claim included the provider's correct individual NPI number and name. The name must be in all capital letters and match what the physician entered in the NPI registry system. The referral physician's name on the claim information should not contain credentials (e.g. MD), titles, or punctuation, except for the hyphen in hyphenated names, and must not be a nickname (e.g. use Robert, not Bob).
posted by The OPBS Team
@
8:42 AM
April 21, 2010
Spinal Orthoses: TLSO and LSO - Policy Article - Effective July 2010
The Coding Guidelines section of the Policy Article states:
Effective for claims with dates of service on or after July 1, 2010, the only products that may be billed using codes L0450, L0454-L0472, L0488-L0492, L0625-L0628, L0630, L0631, L0633, L0635, L0637, and L0639 for prefabricated orthoses are those that are specified in the Product Classification List on the Pricing, Data Analysis, and Coding (PDAC) contractor web site at https://www.dmepdac.com/dmecsapp/do/search.
There are two categories custom fabricated spinal orthoses (codes L0452, L0480-L0486, L0629, L0632, L0634, L0636, L0638, and L0640):
Orthoses that are custom fabricated by a manufacturer/ central fabrication facility and then sent to someone other than the patient. Effective for claims with dates of service on or after July 1, 2010, these items may be billed using one of these codes only if they are listed in the Product Classification List on the PDAC web site.
Orthoses that are custom fabricated from raw materials and are dispensed directly to the patient by the entity that fabricated the orthosis. These items do not have to be listed on the PDAC web site in order to be billed using a custom fabricated spinal orthosis code. However, the supplier must provide a list of the materials that were used and a description of the custom fabrication process on request.
Effective for claims with dates of service on or after July 1, 2010, prefabricated spinal orthoses and spinal orthoses that are custom fabricated by a manufacturer / central fabrication facility which has not received coding verification review from the PDAC must be billed with code A9270.
The Coding Guidelines section of the Policy Article states:
Effective for claims with dates of service on or after July 1, 2010, the only products that may be billed using codes L0450, L0454-L0472, L0488-L0492, L0625-L0628, L0630, L0631, L0633, L0635, L0637, and L0639 for prefabricated orthoses are those that are specified in the Product Classification List on the Pricing, Data Analysis, and Coding (PDAC) contractor web site.
There are two categories custom fabricated spinal orthoses (codes L0452, L0480-L0486, L0629, L0632, L0634, L0636, L0638, and L0640):
Orthoses that are custom fabricated by a manufacturer/ central fabrication facility and then sent to someone other than the patient. Effective for claims with dates of service on or after July 1, 2010, these items may be billed using one of these codes only if they are listed in the Product Classification List on the PDAC web site.
Orthoses that are custom fabricated from raw materials and are dispensed directly to the patient by the entity that fabricated the orthosis. These items do not have to be listed on the PDAC web site in order to be billed using a custom fabricated spinal orthosis code. However, the supplier must provide a list of the materials that were used and a description of the custom fabrication process on request.
Effective for claims with dates of service on or after July 1, 2010, prefabricated spinal orthoses and spinal orthoses that are custom fabricated by a manufacturer / central fabrication facility which has not received coding verification review from the PDAC must be billed with code A9270.
PLEASE VISIT CIGNA GOVERNMENT SERVICES FOR MORE DETAILS @ cignagovernmentservices.com
Effective for claims with dates of service on or after July 1, 2010, the only products that may be billed using codes L0450, L0454-L0472, L0488-L0492, L0625-L0628, L0630, L0631, L0633, L0635, L0637, and L0639 for prefabricated orthoses are those that are specified in the Product Classification List on the Pricing, Data Analysis, and Coding (PDAC) contractor web site at https://www.dmepdac.com/dmecsapp/do/search.
There are two categories custom fabricated spinal orthoses (codes L0452, L0480-L0486, L0629, L0632, L0634, L0636, L0638, and L0640):
Orthoses that are custom fabricated by a manufacturer/ central fabrication facility and then sent to someone other than the patient. Effective for claims with dates of service on or after July 1, 2010, these items may be billed using one of these codes only if they are listed in the Product Classification List on the PDAC web site.
Orthoses that are custom fabricated from raw materials and are dispensed directly to the patient by the entity that fabricated the orthosis. These items do not have to be listed on the PDAC web site in order to be billed using a custom fabricated spinal orthosis code. However, the supplier must provide a list of the materials that were used and a description of the custom fabrication process on request.
Effective for claims with dates of service on or after July 1, 2010, prefabricated spinal orthoses and spinal orthoses that are custom fabricated by a manufacturer / central fabrication facility which has not received coding verification review from the PDAC must be billed with code A9270.
The Coding Guidelines section of the Policy Article states:
Effective for claims with dates of service on or after July 1, 2010, the only products that may be billed using codes L0450, L0454-L0472, L0488-L0492, L0625-L0628, L0630, L0631, L0633, L0635, L0637, and L0639 for prefabricated orthoses are those that are specified in the Product Classification List on the Pricing, Data Analysis, and Coding (PDAC) contractor web site.
There are two categories custom fabricated spinal orthoses (codes L0452, L0480-L0486, L0629, L0632, L0634, L0636, L0638, and L0640):
Orthoses that are custom fabricated by a manufacturer/ central fabrication facility and then sent to someone other than the patient. Effective for claims with dates of service on or after July 1, 2010, these items may be billed using one of these codes only if they are listed in the Product Classification List on the PDAC web site.
Orthoses that are custom fabricated from raw materials and are dispensed directly to the patient by the entity that fabricated the orthosis. These items do not have to be listed on the PDAC web site in order to be billed using a custom fabricated spinal orthosis code. However, the supplier must provide a list of the materials that were used and a description of the custom fabrication process on request.
Effective for claims with dates of service on or after July 1, 2010, prefabricated spinal orthoses and spinal orthoses that are custom fabricated by a manufacturer / central fabrication facility which has not received coding verification review from the PDAC must be billed with code A9270.
PLEASE VISIT CIGNA GOVERNMENT SERVICES FOR MORE DETAILS @ cignagovernmentservices.com
posted by The OPBS Team
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2:50 PM
