Top 5 Questions asked regarding PECOS
At Select Data, PECOS is a “hot” topic. Here are the 5 Top Questions asked of Select Data re PECOS….
Over the past three weeks, the home health industry has been focused on PECOS (Provider Enrollment, Chain, and Ownership System). The final interim rule was published in the Federal Register May 5, 2010, mandating physicians who certify DME and home health services be enrolled in PECOS by July 6, 2010. The situation heated up in June because many physicians thought they had until January 1, 2011. That mistaken information was stated in an April CMS transmittal and has caused confusion and angst within the industry. In addition many physicians, per our clients, thought that being a Medicare provider for years automatically meant they were enrolled in PECOS.
Question 1- An agency asked, can we hold off and see if CMS extends the deadline?
Answer 1- Agencies need to continue to verify that physicians are enrolled in PECOS. Physicians need to verify they are enrolled and active. Some physicians are finding that, though they have been enrolled in Medicare for many years, their information is not appearing in PECOS. If those physicians have not reported any changes to CMS within the past 5 years, they may not have any enrollment records in PECOS. They need to submit a PECOS application.
Question 2- Can a physician submit an application online?
Answer 2 -The PECOS enrollment process has progressed from paper (CMS-855) to an internet-based application process for physicians, non-physician practitioners, providers, and DME supplier organizations to not only enroll but, update their Medicare enrollment information and to verify status of the application process. For further information, go to: www.cms.gov/MedicareProviderSupEnroll/01_Overview.asp
Question 3 - How can a physician tell if (s)he has an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS)?
Answer 3 – Per CMS: There are three ways to verify that you have an enrollment record in PECOS:
1. Check the Ordering Referring Report on the CMS website. If you are on that report, you have a current enrollment record in PECOS. Go to http://www.cms.gov/MedicareProviderSupEnroll, click on “Ordering Referring Report” on the left.
2. Use Internet-based PECOS to look for your PECOS enrollment record. If no record is displayed, you do not have an enrollment record in PECOS. Go to http://www.cms.gov/MedicareProviderSupEnroll , click on “Internet-based PECOS” on the left.
3. Contact your designated Medicare enrollment contractor and ask if you have an enrollment record in PECOS. Go to http://www.cms.gov/MedicareProviderSupEnroll , click on “Medicare Fee-For-Service Contact Information” under “Downloads.”
Note: If you have submitted an enrollment application within the last 90 days, and your enrollment application has been accepted for processing by the carrier or A/B MAC, you need not take any additional actions based on this listserv message. Per CMS
Question 4 – Can I get some online help with enrollment?
Answer 4- Certainly. Tips on how to enroll in PECOS can be found at: www.cms.hhs.gov/MedicareProviderSupEnroll on the CMS website
Question 5 – How will the PECOS system work (once they get physicians enrolled)?
Answer 5 – Refer to the CMS MLN (Medicare Learning Network and reference article MM6856 and the CR 6856 Change Request which requires the NPI for the attending physician on the claim to be valid and enrolled in Medicare.
The FISS (Fiscal Intermediary Shared System will reconcile the physician claim data to the PECOS. To reconcile, the physician (an MD, DO, or DPM) must be enrolled in the Medicare system and be registered in the PECOS system (unless they have opt out status).
The FISS system, using the PECOS system will verify physician validity by matching the NPI number, the first letter of the first name, the first four letters of the last name to the claim information.
The FISS system requires physician enrollment for a valid claim and validity is tied to payment. CMS official instruction is available at www.cms.gov/Transmittals/downloads/R677OTN.pdf
Please be aware that on 6/30/2010 CMS posted the following:
“The Centers for Medicare and Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain, and Ownership System (PECOS) to ensure that Medicare beneficiaries continue to receive the health care services and items they need. PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.
As part of those efforts, CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals, made by providers that have not yet had their applications approved by July 6, 2010. While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS System, some providers have encountered problems. CMS is continuing to update and streamline the process, and more providers have been enrolled in the past few days.”
Tags: CMS, Medicare Reimbursement, PECOS