Physicians who refer or
order services for Medicare patients must be enrolled in PECOS, the
Medicare Provider Enrollment, Chain, and Ownership System database, and
physicians who bill Medicare are required to list the name and National
Provider Identifier (NPI) of the ordering/referring physician on their
claims in order to be paid. The source of these requirements is Section
6405 of the Affordable Care Act.
CMS is about to implement an automatic edit so that claims submitted on or after May 1st
for certain services ordered by a physician or healthcare provider who
is not enrolled in PECOS, even if his or her name and National Provider
Identifier (NPI) are on the claim, will be denied. This change may
affect a relatively small but important set of anesthesiologists, who
have raised questions about the issue. As part of the pre-operative
evaluation of surgical patients, anesthesiologists may order clinical
laboratory or even imaging...
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