Part B Insider (Multispecialty) Coding Alert

Published on Sat Apr 24, 2010 PDF

If you're waiting to get into PECOS, delay no further, CMS says.

CMS recently updated the page on the CMS Web site that lists the ordering/referring providers in PECOS, and it may look different than it used to, said CMS's Jim Bossenmeyer during a May 19 CMS enrollment open door forum.

"There are significantly fewer pages of practitioners," he noted. "The reason for that change is that we're only showing those physicians/eligible professionals that are in an approved enrollment status in PECOS or a valid opt-out status," he said.

Keep in mind: 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. But CMS will start start denying claims that lack this information as of July 6.

Plus: "In addition to requiring the NPI to identify the ordering and referring suppliers on claims, claims from providers and suppliers for items they furnish as a result of orders and referrals must also include the legal name of the ordering and referring supplier, and must have an approved record or a valid opt-out record in PECOS," said CMS's Sandra Olson during the call.

"CMS is well aware of the efforts that many of you have made to comply with the deadline for ordering and referring," Bossenmeyer said. "CMS is listening carefully to the concerns that you have raised about complying with the July 6 deadline, and we are committed to working with you to address those concerns and balance them with our workload capacity," he added.

DMEPOS addition: Beginning on July 13, the PECOS system will be available to DMEPOS suppliers "to enroll, make a change in their enrollment, reenrollment, or withdrawal their enrollment," Bossenmeyer said. He encouraged these suppliers to review CMS's "getting started" guide on the CMS Web site for more information on enrolling in PECOS.

You Can Resubmit Claims After PECOS Enrollment

One caller asked the CMS reps what will happen after July 6 if her practice is in PECOS, but her claim still gets denied because her ordering/referring physician isn't in PECOS. "If we contact them and ask them to get registered in PECOS and they then do, are we going to be able to resubmit that claim and get paid?"

"Yes you would," Bossenmeyer told her. "Since October of last year, you've been receiving informational messages on those eligible professionals who do not have an enrollment record established in PECOS, so if you're working with those individuals over the next months, our Medicare contractors will be working to establish enrollment records as quickly as possible, but you will be able to resubmit those claims."

For more information on the PECOS enrollment system, visit https://pecos.cms.hhs.gov.