Facts you should know about ordering/referring providers for Medicare Part B items and services.
To avoid Medicare Part B claim rejection, wound care providers and suppliers, who are qualified to bill Medicare Part B, should ensure that they are correctly and currently enrolled in the Internet-based PECOS. In addition, wound care providers, who are billing for Medicare Part B-covered items and services that were ordered or referred, need to ensure that the physicians and nonphysician practitioners from whom they accept orders and referrals have current Medicare enrollment records (ie, they have enrollment records that contain their NPIs in PECOS) and are of a type/specialty that is eligible to order or refer in the Medicare program.Wound care providers can verify this by checking the Internet-based Ordering Referring Report. If ordering/referring providers are not yet enrolled in PECOS, remind them that time is running out before the full implementation of the Medicare Part B claims edits on January 3, 2011! For a complete review of the ordering/referring edit process, visit http://www.cms.gov/MLNMattersArticles/downloads/SE1011.pdf.
Schaum
Kathleen D
KD
Kathleen D. Schaum & Associates, Inc, Lake Worth, Florida, USA. kathleendschaum@bellsouth.net
D006801:Humans; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence; D016345:Medicare Part B / Q000191:economics* / Q000331:legislation & jurisprudence* / Q000592:standards; D012017:Referral and Consultation / Q000191:economics / Q000331:legislation & jurisprudence* / Q000592:standards; D014481:United States