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New "Dear Physician" Letter: PECOS is Coming!

Posted by David McGill | December 12, 2013

The Medicare Administrative Contractors have released a new "Dear Physician" letter focusing on the looming PECOS requirements. Here's what you need to know:

  • Effective January 6, 2014, Medicare will start denying claims if the physician's order (i.e., prescription) comes from a doctor who is not enrolled in Medicare's PECOS system.​

What does this mean for you?

If you want to make sure that your orthotic and prosthetic claims don't get denied for yet another technical reason - and one, by the way, that you will not be able to successfully appeal - you must confirm that the prescribing physician is PECOS-enrolled.

How do you do that? 

Click here to go to Medicare's "Ordering and Referring Information" webpage. Scroll to the bottom of the page where it says, "Downloads." There, you can (gasp!) download the "Medicare Ordering and Referring" file in either PDF or Excel format. This contains all of the physicians enrolled in PECOS, and you can confirm that your patient's physician is listed before delivering the orthotic or prosthetic device. 

If you fail to do this and the prescribing physician isn't enrolled, Medicare will deny your claim!

So protect yourself - download the file, integrate this into your claim process immediately, and avoid the pain of PECOS!

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