National Government Services (NGS), the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC), has updated its “Dear Physician Letter” related to the ordering or referring physician’s enrollment into the Provider Enrollment, Chain, and Ownership System (PECOS). The letter is available on the Policy Education page of NGS’ website.
The updates to the letter were based on the recent changes provided in MLN Matters Article SE1305, which states, “Effective May 1, 2013, the Centers for Medicare & Medicaid Services (CMS) will turn on the Phase 2 denial edits. This means that Medicare will deny claims for services or supplies that require an ordering/referring provider to be identified and that provider is not identified, is not in Medicare’s enrollment records, or is not of a specialty type that may order/refer the service/item being billed.”
“Dear Physician Letters” were developed by the DME MAC medical directors for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers to communicate with the physicians about the requirement to enroll in PECOS and be of a specialty type to order/refer DMEPOS items. Suppliers can provide these letters to the ordering/referring physician and/or the Medicare patient for reference.