CMS, Centers for Medicare and Medicaid Services, has implemented a new policy regarding payment for durable medical equipment, prosthetics, orthotics, and supplies. In order for a supplier to receive payment for these supplies, Medicare is verifying that the ordering/referring provider on a DMEPOS claim (1) has a current enrollment record in Medicare (i.e., the ordering/referring provider enrolled or updated his/her enrollment record within the past five years and the NPI is in the record) and (2) is of a specialty that is eligible to order and refer.
If you would like assistance in completing the PECOS enrollment please email us at firstname.lastname@example.org. The charge is $75.00 per provider or if a new enrollment is required(due to inaccurate information) the charge is $275.00.
What is PECOS?
I have an NPI number, am I in PECOS?
The Provider Enrollment, Chain and Ownership System (PECOS) is an online system that allows you to manage your physicians, or other healthcare practitioners, provider file at Medicare. Medicare requires that you register with their PECOS system by January 4, 2010 to prevent claim denials for items that you prescribe.
If you are not enrolled in internet PECOS claims for items that you prescribe or previously prescribed (if being rented) will begin to reject as of April 5, 2010.
What does the acronym PECOS mean?
The Provider Enrollment, Chain and Ownership System.
I’m already enrolled in Medicare, do I need to enroll with PECOS also?
YES! You must enroll with PECOS before April 5, 2010. If you have enrolled with the program since 2003 you may already be in the system. HOWEVER, it is very important to your patients that you verify your PECOS status. Otherwise they may not receive the items you prescribe.
I’m enrolled as part of a group with Medicare. Am I in PECOS?
NO! You need to enroll individually.
Why haven’t I heard of it before?
Medicare has encouraged physicians to update their provider files since 2006. However, it has never impacted the payment of claims for referred items or services. Beginning in October of 2009 the first phase of the system was implemented.
Under the first phase claims are being paid but with a warning that the provider is not in the PECOS system.
The second phase begins on January 4, 2010. At that time claims for items referred by physicians who are not in the system will deny.
What other professionals must register with PECOS? Non-physician practitioners who are eligible and those are:
* Physician Assistants
* Certified Clinical Nurse Specialists * Nurse Practitioners
* Clinical Psychologists
* Certified Nurse Midwives
* Clinical Social Workers Probably not. Your National Provider Identification (NPI) is not registered with the PECOS system until you complete the registration process.
What happens if I do not register?
Beginning April 5, 2010 any claims for items or services that you have prescribed will be denied if you are not in the PECOS system. This applies to Medicare claims only. Not being in the PECOS system will make it difficult for your patients to receive the items they need and will prevent / delay hospital discharges.
Also, you may have previously prescribed items that are being rented. These items can go back three years or more (oxygen for example). These claims will also deny if you are not registered with PECOS.
How to register with PECOS:
- Have an NPPES User ID and password to use Internet-based PECOS.
- Go to Internet-based PECOS at: https://pecos.cms.hhs.gov and complete the electronic enrollment.
- Print, sign and date and mail the 2-page Certification Statement as instructed.
Need more info?
www.getpecos.com is not a CMS / Medicare website. It is part of an campaign designed by HME providers to make physicians aware of PECOS.
Effective April 5, 2010 if you are not registered with Medicare’s PECOS claims for items you prescribe will be rejected.