tci Part B Insider - 2013 Issue 10

Ordering/Referring: 6 Steps Help You Reduce PECOS Edit Losses

Tip: Check your current referring info to avert financial crisis in May. You’d better get your ordering/referring physician info right the first time around under PECOS edits, or you’ll pay a steep price. Phase 2 of PECOS edits hits May 1, and they’ll slap you with costly denials as opposed to less burdensome returned claims when you have invalid ordering/referring physician information (see the Insider v. 14 number 9, cover page, for more information). The system will deny claims when the doctor isn’t in the Provider Enrollment, Chain, and Ownership System (PECOS) file or when...

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