Practice Management Alert

Question: I keep hearing about PECOS, but I'm so confused about the whole thing. Do I need to do something to enroll my physicians?

Alabama Subscriber

Answer: If your provider orders or refers services and supplies, he must be enrolled in Medicare's Provider Enrollment, Chain, and Ownership System (PECOS) by April 5 or you'll face denials. Additionally, if your physician provides services which require a referring physician, the referring physician must be enrolled in PECOS by April 5, or you'll face denials as the providing physician.

Previously, CMS had indicated that the deadline for PECOS updates by ordering/referring providers would be Jan. 4, but a Nov. 23 directive delayed the deadline by three months "to try to give the physicians and non-physician practitioners who can order and refer an opportunity to get their enrollment records into PECOS," said CMS's Pat Peyton during a CMS-sponsored Open Door Forum.

If you bill an item or perform a service that was ordered or referred by another practitioner, your claim must include the referring or ordering practitioner's national provider identifier (NPI) and that number must be in the PECOS system.

"A lot of them [the providers] are in Medicare but have not updated their records in six or more years, and they need to revalidate their information in order to get them into PECOS," Peyton said on the call.

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, you'll get an informational message letting you know that the practitioner's information is missing from the system. Come April, however, that message will be in the form of a denial. Even if the record is in PECOS, if the  PI is not recorded, you'll get that informational error message.

Silver lining: CMS intends to help your transition to using the PECOS system. The weekend of Dec. 12, CMS input the NPIs of over 230,000 practitioners into the PECOS system on providers' behalf, so your provider may already be in the system.

For more information, visit the CMS Web site at www.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp.