Home Health & Hospice

Q: What is the current status of PECOS?

Homecare Insider, June 24, 2013

Q: What is the current status of PECOS?

A: According to CMS, due to technical issues, implementation of the Phase 2 ordering and referring denial edits is being delayed.  

These edits would have checked certain claims for an approved or validly opted-out physician or non-physician who is an eligible specialty type with a valid individual National Provider Identifier (NPI).

If this information were missing or incorrect, the following types of claims would deny:

  • Claims from laboratories for ordered tests;
  • Claims from imaging centers for ordered imaging procedures; and
  • Claims from suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for ordered DMEPOS.
  • Claims from Part A Home Health Agencies (HHA)

CMS will alert providers of the new implementation date in the near future. In the interim, informational edits will continue to be sent for those claims that would have been denied had the edits been in place.

Read the announcement here.

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