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Lymphland International Lymphedema Online
January 23, 2012
PECOS Warning Edit Change (CEDI Message)
Effective January 01, 2012 the durable medical equipment Medicare administrative contractors (DME
MACs) began to return warning messages if the ordering or referring provider on the claim is not eligible to
order or refer DME supplies as determined from Provider Enrollment Chain & Ownership System
(PECOS). These messages are returned on the electronic remittance advice (ERA) or standard paper remit
(SPR) with the following remittance advice remark code (RARC) and will apply to both 4010A1 and
5010A1 formatted claims:
N544 - Alert: Although this was paid, you have billed with a referring/ordering provider that does not match
our system record. Unless, corrected, this will not be paid in the future.
Through January 29, 2012 the Common Electronic Data Interchange (CEDI) will continue to return the
PECOS warning edits for 4010A1 claims on the GenResponse Report.
The Centers for Medicare & Medicaid Services (CMS) and the DME MACs will communicate when the
edits will become denials when that date is determined.
President Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 (TPTCCA)Section 304
of the TPTCCA extends the exceptions process for outpatient therapy
caps. Outpatient therapy service providers may continue to submit claims with
the KX modifier, when an exception is appropriate, for services furnished on or
after January 1, 2012, through February 29, 2012.
The therapy caps are determined on a calendar year basis, so all patients begin
a new cap year on January 1, 2012. For physical therapy and speech language
pathology services combined, the limit on incurred expenses is $1,880. For
occupational therapy services, the limit is $1,880. Deductible and coinsurance
amounts applied to therapy services count toward the amount accrued before a cap
is reached, and also apply for services above the cap where the KX modifier is
used.
Robert Weiss, M.S.
Lymphedema Patient Advocate
National Lymphedema Network
PECOS Warning Edit Change (CEDI Message)
Effective January 01, 2012 the durable medical equipment Medicare administrative contractors (DME
MACs) began to return warning messages if the ordering or referring provider on the claim is not eligible to
order or refer DME supplies as determined from Provider Enrollment Chain & Ownership System
(PECOS). These messages are returned on the electronic remittance advice (ERA) or standard paper remit
(SPR) with the following remittance advice remark code (RARC) and will apply to both 4010A1 and
5010A1 formatted claims:
N544 - Alert: Although this was paid, you have billed with a referring/ordering provider that does not match
our system record. Unless, corrected, this will not be paid in the future.
Through January 29, 2012 the Common Electronic Data Interchange (CEDI) will continue to return the
PECOS warning edits for 4010A1 claims on the GenResponse Report.
The Centers for Medicare & Medicaid Services (CMS) and the DME MACs will communicate when the
edits will become denials when that date is determined.
President Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 (TPTCCA)Section 304
of the TPTCCA extends the exceptions process for outpatient therapy
caps. Outpatient therapy service providers may continue to submit claims with
the KX modifier, when an exception is appropriate, for services furnished on or
after January 1, 2012, through February 29, 2012.
The therapy caps are determined on a calendar year basis, so all patients begin
a new cap year on January 1, 2012. For physical therapy and speech language
pathology services combined, the limit on incurred expenses is $1,880. For
occupational therapy services, the limit is $1,880. Deductible and coinsurance
amounts applied to therapy services count toward the amount accrued before a cap
is reached, and also apply for services above the cap where the KX modifier is
used.
Robert Weiss, M.S.
Lymphedema Patient Advocate
National Lymphedema Network