CMS Delays PECOS Edit, New Implementation Date Unknown
Tuesday, April 30, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy

Due to technical issues, the Centers for Medicare and Medicaid Services (CMS) have delayed the implementation of the Phase 2 ordering and referring denial edits. These edits would have affected home health claims that list attending physicians with a missing or incorrect PECOS enrollment record.
CMS had planned to implement an edit to deny such claims for services provided on or after May 1. In the meantime, CMS will continue to assign remark code N272 to claims that would have failed the edit.
The edits had already been delayed several times, with previous implementation dates set for July 2010, January 2011 and July 2011.
Recent analyses by the Medicare administrative contractors showed that the impact of the edit, once implemented, could be significant. To learn more about the impact analysis, please review this VNAA Member Update article.
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