Centers for Medicare & Medicaid Services (CMS) will deny claims when the ordering or referring provider is not enrolled in Medicare. The CMS will deny Part B Durable Medical Equipment (DME) and Part A Home Health Agency (HHA) claims when the practitioner does not have a current Medicare ...
CMS has not yet decided when it will begin to reject claims if an ordering/referring provider does not have a Provider Enrollment, Chain and Ownership System (PECOS) record. CMS will give providers ample notice before claim rejections begin. ...
CMS Delays Edits to Deny Claims When Ordering/Referring Provider Not Enrolled in Medicare and Issues Proposed Rule on Enrollment RestrictionsJoan PolacheckMonica Wallace