Medicare provider enrollment PECOS - FQHC billing
As most of you are aware, Medicare postponed implementation of edits to deny claims when/if the ordering/referring provider is either not enrolled in Medicare and/or does not have a current PECOS record. There were a great many questions as to why this was required for FQHC providers as they are reimbursed at the all-inclusive rate and do not require individual provider enrollment applications.
CMS has now published guidance for those providers that ‘infrequently receive reimbursement from the Medicare program.’ One of the specific provider types mentioned is those employed at an FQHC. They have abbreviated the application process but it indicates that it must be completed on paper and include a letter to advise that it is for the sole purpose of ordering/referring services for Medicare beneficiaries and CANNOT be reimbursed for services performed.
While it sounds like they were being sensitive to the facts, it does not eliminate the need to complete the full 855I and R to capture payment for any services that are carved out of the FQHC Medicare contract.
Here is the link and there are a few included in the document that you may want to check out. I haven’t read through them all but will do so. I also haven’t seen when the edit will be put into place as a final rule but we need to get ahead of the curve, just in case.
By: Kristie Sell Viveiros, CPC, VP of Billing Operations Priority Management Group, Inc