Part B Insider (Multispecialty) Coding Alert

Published on Fri May 31, 2013 PDF

Plus: At long last, CMS has a permanent administrator.

You diligently transferred your Medicare enrollment records over from the old NPPES system to the PECOS system, but don’t pat yourself on the back just yet. The OIG recently reviewed provider enrollment files and found that many of them were wildly inaccurate, while others were incomplete.

The OIG report, “Improvements Are Needed to Ensure Provider Enumeration and Medicare Enrollment Data Are Accurate, Complete, and Consistent,” involved reviewing a random sample of individual Medicare providers to determine how accurate the provider information was in NPPES and the more recent PECOS system. As a result, OIG found that 48 percent of NPPES records were inaccurate, but that a startling 58 percent of PECOS records were inaccurate, while another four percent were incomplete.

The OIG also found that provider data was inconsistent between NPPES and PECOS for a full 97 percent of the provider records. The main culprit? Practice addresses – which are essential for contacting providers – were the main source of inaccuracies and inconsistencies.

Part of the problem stemmed from the fact that CMS did not verify most provider information in either enrollment system, the OIG said. The agency urged CMS to verify more enrollment records and to detect and correct issues that it finds. Since CMS agreed with these recommendations, expect upcoming contact from your MAC if you made any errors while enrolling your practitioners.

To read the complete report, visit http://go.usa.gov/b4MC