Some 40% of agencies billing to Palmetto would have seen at least one denial in January or February if the edit for attending physician enrollment in PECOS had been active.
 
Palmetto’s analysis, published April 10, comes on the heel of a similar one by fellow Medicare administrative contractor (MAC) CGS. CGS found that three out of four agencies billing to it would have seen denials between September 2012 and February 2013.
 
Both MACs based their analysis on which claims received remark code N272, which indicates that the physician’s information is either invalid or incomplete based on CMS’ ordering/referring file. The code, which has been assigned to claims since 2009, is currently purely informational, but indicates that the claim will be denied once CMS turns on the PECOS edit May 1.
 
Palmetto reminds agencies that to pass the edit, a claim must contain the national provider identifier (NPI) of an individual physician, not a group practice.