PECOS Update
CMS has delayed the implementation of Phase 2 of CMS Change Request (CR) 6421 for DMEPOS suppliers and CR 6417 for Part B providers until January 3, 2011.
Change Request 6421, Expansion of the Current Scope of Editing for Ordering/Referring Providers for DMEPOS, requires Medicare implementation of system edits to assure that DMEPOS suppliers bill for items or services only when those items or services are ordered or referred by physician and non-physician practitioners who are eligible to order/refer such services. Physician and non-physician practitioners must be enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and of the type/specialty eligible to order/refer services for Medicare beneficiaries.
The Phase 2 implementation of this requirement has been delayed to January 3, 2011, to give physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers sufficient time to enroll in Medicare or take the action necessary to establish a current enrollment record in Medicare.
Physician NPI File
The file containing the NPI and name of all physicians and non-physician practitioners who are of a type/specialty that is eligible to order and refer in the Medicare program and who have current enrollment records in Medicare is downloadable from the Medicare provider/supplier enrollment Web site: http://www.cms.hhs.gov/MedicareProviderSupEnroll 
- click on "Ordering/Referring Report" on the left-hand side.
Phases
Phase 1: October 5, 2009 - January 2, 2011
Medicare will verify that the ordering/referring provider on the claim is in PECOS and is eligible to order/refer in Medicare. If the ordering/referring provider is not in PECOS or is in PECOS but is not of the type/specialty to order or refer, the claim will continue to process.
- If the claim is electronic, the supplier will receive a warning message on the Common Electronic Data Interchange (CEDI) GenResponse Report.
- If the claim is paper, the supplier will not receive a warning and will not know that the claim did not pass these edits.
Phase 2: January 3, 2011 and thereafter
If the ordering/referring provider:
- Is not on the claim, the claim will not be paid.
- Is on the claim, Medicare will verify that the ordering/referring provider is in PECOS and eligible to order and refer.
- Is not in PECOS or is in PECOS but is not of the specialty to order or refer, the claim will not be paid. It will be rejected.
