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PECOS Deadline now July 1st

Posted by: Sabrina | Comments (0)
Monday, June 21st, 2010

It is important to note that this deadline could once again be extended to January but we recommend taking care of this requirement now.

An interim final rule issued by the Centers for Medicare & Medicaid Services (CMS) requires physicians and other eligible professionals (EPs) who order or refer most types of covered Medicare services and items to have an active record in the Provider Enrollment, Chain, and Ownership System (PECOS) much sooner than expected. A group of medical associations continues to urge CMS to reconsider the recent ruling.

According to the health reform law the Obama administration enacted this year, the American Medical Association (AMA) says, only physicians who order and refer durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) or home health services for Medicare beneficiaries are required to be enrolled with Medicare through PECOS by July 1.

This legislation, however, gives the Secretary of Health and Human Services (HHS) the authority to extend the requirements to other items or services. CMS, according to the interim final rule published May 5 in the Federal Register, also is requiring physicians and EPs who order or refer imaging, laboratory and specialist services to be enrolled in PECOS by July 6.

“Physicians have been operating under the assumption that they had until Jan. 3, 2011,” writes amednews staffer Chris Silva, June 14.

According to the rule, CMS is requiring for “Part B claims for covered services of laboratories, imaging suppliers, and specialists … the ordering or referring supplier be a physician or an eligible professional with an approved enrollment record in PECOS.”

“The AMA and more than 40 other physician organizations contend otherwise, noting in a May 28 letter to CMS that the regulation goes beyond what is called for in the health reform statute,” writes Silva.

CMS says physicians and EPs can avoid this requirement by opting out of Medicare and entering into private contracts with Medicare beneficiaries. However, the process of opting out in fact creates a valid record in PECOS, and physicians and EPs not enrolled in Medicare are still required to include their National Provider Identifier (NPI) in Medicare claims.

For more details, read “Physician Deadline for Medicare PECOS Enrollment Moved Up to July” on amednews.com.

You can also feel free to email us at info@drcred.com with any questions or concerns.

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Categories : PECOS Medicare
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PECOS Closed March 29th-April 5th

Posted by: Lauren | Comments (0)
Monday, March 29th, 2010

Remember that PECOS will be closed for maintenance starting today through April 5th. We confirmed that today that this should not affect any pending Medicare enrollment applications processed through PECOS prior to March 29th. We as many other organizations utilize PECOS for our provider applications and appreciate them taking the time to address some of the bugs in the system.

PECOS is utilized for Provider/Supplier Enrollment applications and uses your NPI login information. If you are not enrolled in PECOS, this is the year to fix that. You basically need to revalidate your enrollment record if you are not currently listed in PECOS.

For questions please register for our forum and create a topic/question which will be answered by a credentialing specialist within 24-48 hours.

Categories : Medicare Credentialing, PECOS Medicare
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CMS Delays Ordering/Referring PECOS Regulation Until 2011

Posted by: Lauren | Comments (2)
Friday, February 26th, 2010

Okay so you have some breathing room but — don’t wait until the end of the year, CMS reps say.

Practices that have been struggling to make sure that their ordering/referring physicians’ national provider identifiers (NPIs) were in the PECOS system can now relax a little bit – at least until next year.

If your physician performs a service as the result of an order or referral, your claim must include the ordering or referring practitioner’s NPI, and that number must be in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) or the payer’s computer system.  As many of you know, on April 5th, CMS was going to begin denying your claim if the referring physician’s information was no in the MAC’s claim system or PECOS.  Currently, if the physician’s information is missing from the system you will receive a notification message advising you of this fact.

Because of number of physicians that have yet to enroll in PECOS, CMS has decided to push back the compliance date until Jan. 3, 2011, announced CMS’s Jim Bossenmeyer during a Feb. 17 CMS Open Door Forum. Repeating the information twice because of its importance, Bossenmeyer said, “CR 6417 and CR 6421 have been delayed until January 3, 2011.”

Don’t waste the extra time: Although many of you are breathing a sigh of relief, Mr. Bossenmeyer also made it clear to not wait until the last minute to register.

“The delay in implementing Phase 2 of these CRs will give physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers sufficient time to enroll in Medicare or take the action necessary to establish a current enrollment record in Medicare prior to Phase 2 implementation,” the CMS Web site indicates.

If you are unsure of whether your information is in the PECOS system, you review our previous post which includes a copy of the PECOS database.

Avoid Enrollment Application Lags

Also on the call, Bossenmeyer indicated that the number one reason for delayed processing of paper Medicare enrollment applications (855-I or 855-B forms) is “incomplete applications or delays in the submission of developmental materials.” CMS “strongly encourages” providers to use internet-based electronic PECOS, which is results in fewer errors. Always remember to sign, date, and mail your certification statement and any supporting documentation, Bossenmeyer noted.

DMEPOS suppliers will have internet-based PECOS availability later this year, Bossenmeyer said.

Get New Docs Into PECOS

One caller noted that her practice hired a new physician who moved from Oregon to Wyoming, but was remaining with the same MAC with which he was previously enrolled, despite moving from one state to another. Even in this case, the new practice should complete a new PECOS application for the physician.“Medicare enrolls physicians and NPPs (non-physician practitioners), along with groups, by state, not by MAC jurisdiction,” a CMS rep. noted on the call. “So if you’re in Montana and you’re in Utah, you should be enrolling twice – once for each state.” This is a common misperception and is unfortunate because of how much money it ends up costing physicians across the country.  And now, because of only allowing 30 days of retroactive billing, you could find yourself writing off thousands of dollars because of an incorrect enrollment application.

Categories : Medicare Credentialing, PECOS Medicare
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Medicare Referring Provider Documentation

Posted by: Lauren | Comments (0)
Tuesday, February 16th, 2010

If you have already registered with PECOS here is the documentation from CMS providing you with the List of Providers who are also registered in PECOS.  It is important to remember that a provider you refer to must also be in PECOS or you risk having your claim denied by Medicare.  This is working out to be very similar to the NPI transition a few years ago which everyone should remember with different phases and penalties.  Will they ever stop changing things, I guess for the sake of our business we should hope not…

PECOS is a great system but does still need some major improvements.  If you are unsure if you are enrolled properly, visit www.pecos.com and login using your Individual NPI information. You will want to view My Enrollments and see what shows up.  Odds are that if nothing is listed under My Enrollments then you are not entered into their system properly.

You can also use this document below to see if you are listed in Pecos.

Download the referring provider list here.

Categories : Medicare Credentialing, PECOS Medicare
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