Alert: Inspector General Demands Physicians Improve Records for NPI Files and PECOS or Face Losing Medicare Revenue

June 19, 2013 by Wellons Communi...

HHS investigation says poor records can signal Medicare fraud. The Office of Inspector General (OIG) is sounding the alarm on inconsistency in practitioners’ records: clean up inaccuracies or face not getting paid for your work.

In a report released last month, the investigative arm of the Department of Health and Human Services (HHS) stated 97 percent of provider records had some type of inaccuracy. The OIG compared Medicare enrollment records in PECOS with NPI files and found most of the inconsistencies involve out-of-date or incorrect addresses.

OIG, which is charged with preventing Medicare fraud, sees the shoddy record keeping as a pathway for practices to overcharge. The agency told the Centers for Medicare & Medicaid Services (CMS) that practices must make improvements or have their reimbursement requests disallowed. CMS agreed with the report’s findings and have pledged to implement more aggressive information audits, among other changes. For details go to:

The bottom line of the warning – practices must get NPI records consistent with PECOS or face extremely damaging revenue reduction.

Here are the action steps your practice should take:

  • Immediate review of your NPI files and make sure they are consistent with PECOS
  • Continual update of your NPI files moving forward to make sure the information stays in compliance
  • Add a step to your record process that mandates a scheduled check of these critical records

ACT NOW: Greater scrutiny for Medicare enrollment process is here. Make sure you are covered.

From benchmarking your most important revenue numbers, to alerting you to what the latest government rules mean, to medical billing – NCG Medical is your complete practice management team. Call today, 800-959-1906, to schedule a complementary analysis to learn pathways to improve profits.

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