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PECOS

Have you been hearing a lot of talk about PECOS lately, and wonder what is the big deal and why is Medicare concerned about some river or a city in Texas?  Well it is not the location, I am sorry to say, that is the topic of discussion.  PECOS is one more hoop to jump through to get your Medicare claims paid.  A few weeks ago we sent out an email to all practices stating that effective January 3, 2011 CMS would begin to reject and not pay for claims if the ordering/referring physician is not enrolled in the Provider Enrollment, Chain and Ownership System (PECOS).  At this time, CMS has not turned on the automated edits that would deny claims for services that were ordered or referred by a physician or other eligible professional simply for lack of an approved file in PECOS.  CMS has not announced any date as to when ordering/referring edits will be turned on. However, while PECOS may not be going into effect on January 3^rd, know that it will be turned on in the future.

If you order or refer items or services for Medicare patients (e.g. lab test, x-rays, diabetes self management training, medical nutrition therapy, durable medical equipment or supplies etc.) and you do not have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS), you need to submit an enrollment application to Medicare.

Physicians or other eligible professionals not currently enrolled in PECOS should take the initiative to enroll sooner rather than later. There are three ways to verify that you have an enrollment record in PECOS:

• Check the Ordering Referring Report on the CMS website, available at http://www.cms.gov/MedicareProviderSupEnroll/06_Medicare
  OrderingandReferring.asp. If you are listed on that report, you have a current enrollment record in PECOS.
• Use Internet-based PECOS to look for your PECOS enrollment record, available at http://www.cms.gov/MedicareProviderSupEnroll/04_Internet
  basedPECOS.asp. If no record is displayed, you do not have an enrollment record in PECOS.
• Contact your designated Medicare enrollment contractor and ask if you have an enrollment record in PECOS. Visit www.cms.gov/MedicareProviderSupEnroll for the "Medicare Fee-For-Service Contact Information" list (in the "Downloads” section).

We at RANAC are happy to check the PECOS Ordering/Referring list for you to see if your doctor(s) are on the list. In order for us to check for you please email or fax the doctor's full names and Individual NPI number.  If your doctor(s) are not on the list and you meet the criteria above you MUST enroll them on PECOS.  While we are happy to check the list for you, we will be unable to submit an enrollment application for you.

If you are not yet in PECOS, the best way to submit your application is through internet-based PECOS. For more information, visit http://questions.cms.hhs.gov/app/answers/detail/a_id/10038/kw/pecos.

Good luck with this adventure.

Here is wishing you health, happiness and prosperity in the New Year.