Part B Insider (Multispecialty) Coding Alert

Published on Sat Jun 05, 2010 PDF

Despite the fact that the PECOS deadline is near, you needn't worry about denials -- yet

The July 6 PECOS deadline is nearly upon medical practices, but many report that the closer the deadline gets, the more difficult it is to access CMS's system.

If your physician performs a service as the result of an order or referral, your claim must include the ordering or referring practitioner's national provider identifier (NPI), and that number must be in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) or the payer's computer system. Currently, if you submit claims for services or items ordered/referred and the ordering or referring physician's information is not in the MAC's claims system or in PECOS, your practice will get an informational message letting you know that the practitioner's information is missing from the system. The deadline to get into the PECOS system is July 6.

Don't panic if you're not in the system: Although the July 6 deadline is right around the corner, you don't need to worry about denials just yet. Despite initial news suggesting that ordering/referring providers who weren't in PECOS by July 6 would face denials, CMS has extended that period.

"While the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS," CMS said in a June 30 statement. "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."

Expect Delays in PECOS System

In the meantime, if you aren't yet in the PECOS system, you should enroll as soon as possible. Practices have reported delays on the CMS Web site, most likely due to an overwhelming number of people trying to access the system.

For example: One physician stayed on the PECOS system more than seven hours trying to check the doctor's enrollment status, but the system was so overloaded she couldn't complete the process, says Serese Wiehardt with Howard County Home Health and Hospice in Fayette, Mo.

Other physicians report receiving PECOS approval letters months ago, but still not being listed in CMS's file of PECOS-enrolled physicians on the website, Wiehardt relates.

CMS updates its PECOS file only every four to six weeks, which makes it hard for providers to figure out whether their referring physicians are actually enrolled yet.

At least one technical problem has been resolved: CMS has posted the PECOS-enrolled physician file using a more user-friendly comma separated value (CSV) format, which can be opened in MS Excel, and therefore eliminates the lengthy PDF file search process providers were being forced to perform.

To enroll in PECOS or get more information, visit https://pecos.cms.hhs.gov/pecos/login.do. To find the list of ordering/referring providers listed in PECOS, visit www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp.