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Pecos

  1. Default Pecos
    Exam Training Packages
    Sorry to get off the coding topic but what is the reason for this new credentialing "hoop" that Medicare is requiring? I don't get it.

  2. #2
    Default Director of billing
    I dont either...i am still working on getting it done for our clinic...very frustrait and to get someone you can undertand on the phone good luck!

  3. #3
    Location
    Ellenville, New York
    Posts
    1,176
    Default Internet-based enrollment
    PECOS is simply a means of enrolling or updating a physician's information to CMS via the internet. It is NOT required to be used in order to participate in Medicare. Go to this page on the CMS web site: http://www.cms.hhs.gov/MedicareProvi...ingStarted.pdf and scroll down to page 9 in the FAQ's. It states that enrolling in PECOS is optional. I have seen deadlines for certain information that must be sent from our contractor, but those are for those providers who started the PECOS process and must send information in the next steps by a certain date.

    Are these requirements sent from your contractor? Maybe they are contractor-specific?

  4. #4
    Default
    PECOS is not optional any longer. In order for Medicare to pay for any radiology or DME, those things must be ordered by a physician enrolled in PECOS. If your physician doesn't ever order any of these things, then I suppose you are ok, but I've never meet a doctor that doesn't order an xray or an MRI at least every once in a while...
    Walker Bachman, CPC, CPPM

  5. #5
    Location
    Ellenville, New York
    Posts
    1,176
    Default Getting scary here..
    when I go straight to the horse's mouth, so to speak, and the information I get is incorrect. Walker, do you have the documentation that stated it is no longer optional?

  6. #6
    Default
    I should re-phrase that.. it IS optional. BUT...

    If a referring doctor orders a service, but is not registered with PECOS, CMS will not pay for it. I will see if I can find the documentation. Watch this space...

    ADDENDUM:

    http://www.managemypractice.com/is-y...cos-countdown/

    http://physiciancredentialingservice...ne-enrollment/
    Last edited by Walker22; 02-15-2010 at 07:25 AM.
    Walker Bachman, CPC, CPPM

  7. #7
    Location
    North Carolina
    Posts
    3,126
    Default
    Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and also contains the physician/non-physician practitioner's National Provider Identifier (NPI). Under Phase 2 of the above referenced CRs, a physician or non-physician practitioner who orders or refers and who does not have a current enrollment record that contains the NPI will cause the claim submitted by the Part B provider/supplier who furnished the ordered or referred item or service to be rejected.

    http://www.cms.hhs.gov/MedicareProvi....asp#TopOfPage

  8. #8
    Default
    Thanks Rebecca.... I knew I had seen the CMS transmittal, but couldn't put my hands on it...
    Walker Bachman, CPC, CPPM

  9. #9
    Location
    North Carolina
    Posts
    3,126
    Default Update
    MGMA advocacy leads to delay in PECOS requirements for ordering/referring providers

    Written by MGMA Government Affairs Department, Washington, DC
    Thursday, 18 February 2010 08:09

    As a result of the Medical Group Management Association (MGMA) and other associations' advocacy efforts, the Centers for Medicare & Medicaid Services (CMS) will delay implementation of the second phase of modifications to the Provider Enrollment, Chain, and Ownership System (PECOS) regarding ordering/referring providers from April 5 until Jan. 3, 2011. The requirements stipulate that:

    All Medicare providers who order or refer for non-durable medical equipment (DME) items or services be enrolled in PECOS or the Medicare carrier's or Part B MAC's (spell out MAC's on first reference) claims system; and

    Medicare providers who order or refer DME claims be enrolled in PECOS.
    Providers who enrolled in Medicare prior to 2003 but have not completed the revalidation process are not included in PECOS. CMS will reject these provider's claims and therefore deny payment.

    Prior to the Jan. 3, 2011, implementation date CMS will:

    Continue to place warnings on claims in which the ordering/referring is not enrolled in PECOS;

    Update the Medicare Ordering/Referring File;
    Remind providers who enrolled in Medicare prior to 2003 but have not completed the revalidation process to submit a new enrollment application either in the paper form or by using Internet-based PECOS.


    http://new.mgmanv.org/component/cont...providers.html

  10. #10
    Default
    Thanks Rebecca... good to know! I'm going to pretend the dealine is still April 5 and just get it done so I don't have to worry about it!
    Walker Bachman, CPC, CPPM

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