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Watch for PECOS warning on DMEPOS remittance advice

November 16, 2011

Optometrists who provide eyeglasses to Medicare patients using prescriptions that are written by other physicians should watch for the notice “Ordering Provider Not Authorized” on remittance advice forms, the AOA Advocacy Group warns. The advisory indicates that Medicare, in the future, will not cover eyewear ordered by the optometrist or ophthalmologist listed on the prescription because the prescriber does not have a complete enrollment record in Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS).

Provisions in last year’s federal health reform law, designed to prevent Medicare fraud and abuse, allow the government health plan to pay for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) – including post-cataract eyeglasses – only when prescribed by a health care practitioner who is properly enrolled in Medicare.

CMS officials emphasize that they have not yet set a deadline by which all “ordering/referring” practitioners must be enrolled as Medicare physicians through PECOS. Practitioners who receive Medicare remittance advice for eyewear claims with the “Ordering Provider Not Authorized” warning may wish to advise the prescribing practitioner.

To have a complete enrollment record in the Medicare PECOS database, the doctor must re-enroll in Medicare as a physician.  The doctor can re-enroll using a paper enrollment form (CMS-855) or online (https://pecos.cms.hhs.gov).

For additional information, see the AOA Web site PECOS page (www.aoa.org/PECOS) or the CMS Web site Medicare Ordering and Referring page (http://tinyurl.com/MedicareOrderRefer).

One comment

  1. […] Optometrists who provide eyeglasses to Medicare patients using prescriptions that are written by other physicians should watch for the notice “Ordering Provider Not Authorized” on remittance advice forms, the AOA Advocacy Group warns. The advisory indicates that Medicare, in the future, will not cover eyewear ordered by the optometrist or ophthalmologist listed on the prescription because the prescriber does not have a complete enrollment record in Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS).Source: newsfromaoa.org […]



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