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ACR News: PECOS Enrollment Deadline for Referring Physicians Clarified

(ACR) -- The Centers for Medicare and Medicaid Services (CMS) held an open door forum to clarify the May 5, 2010, federal register notice announcement that the referring or ordering physician is required to establish an enrollment record in the Provider Enrollment, Chain, and Ownership System (PECOS). CMS noted that although the regulation will become effective on July 6, 2010, the implementation date of the regulation is January 3, 2011. This means that although physicians should be enrolled by the July 6 deadline, CMS will not start rejecting claims for those not enrolled in the PECOS until January 3, 2011. This is in accordance with the Patient Protection and Affordable Care Act, which requires that a National Provider Identifier number be on enrollment applications and claims in order to help CMS deter fraud and abuse.


In addition, CMS also announced their plan to make changes to the Program Integrity Manual that would make the contents of enrollment guidelines in the manual to match what is mandated in the regulation. As a result, Publication 100-08, Chapters 10-15 will be affected.


For a complete listing of physicians who are eligible to order or refer Medicare patients, see the CMS Ordering and Referring Physicians file. Only those practitioners who are enrolled in the PECOS system at this time are listed.


For more information on the PECOS, please see the summary of the final rule.


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