PECOS Issues
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Hopefully, this will be the last article on enrollment for a while. My own recent personal experience with Medicare and PECOS AKA Provider Enrollment, Chain and Ownership System, is the subject for a portion of this article.
PECOS is the electronic mechanism for establishing all forms of Medicare enrollment. Because this effects all types of providers and the changes implemented may not be so visible to the average provider, a current view of the major changes to PECOS is the subject of this week’s column. As this column has repeatedly stated, it is best to have professional work with you on any matter related to Medicare enrollment. Even the smallest of errors may have grave consequences to any of your Medicare enrollments (Medical or DME).
- Before you use the actual enrollment portion of PECOS, you must have registered with the Identity and Access Management System (I&A) within PECOS. The changes to the I&A system are simple. One must regularly enter the I&A system using your username/password and PIN. If you have lost/misplaced your password, PIN or username you will need to follow the steps required to restore those to your account.
It is a good idea to have a trusted back up professional besides someone in your office who can retrieve and/or access/modify this information.
The I&A system should be accessed on a regular basis. Failing to do so may result in your PECOS enrollment being terminated, having grave consequence to your enrollment/reenrollment and the financial health of your practice. More on the implication f your PECOS enrollment later in Section 4. - Once you have properly completed/edited your I&A enrollment you can move onto the actual main portion of PECOS, where the “meat” of your Medicare enrollment will take place. Again, this section of the PECOS application should be reviewed regularly. Failure to update changes which may have occurred since your last enrollment may subject you to revocation.
- Regardless of your enrollment needs for DME or your local Medicare contractor (initial, revalidation, modifying an existing account for any number of reasons such as employment issues or new office locations), your application will need to be submitted via PECOS. This area is especially where the assistance of a professional will save you time, money and heartache.
- The last section of this article will highlight a recent experience of mine. One may refer to this as the “Shoemaker’s Daughter” syndrome. Several months ago because of failure to submit any claims to the DME and the local Medicare contractor for a period of time, my Medicare enrollment was terminated. This did not cause any angst because the author is non-clinical and does not bill Medicare. As this has gone on for quite some time this was not unexpected. The professional my firm uses for my client’s enrollment also thought nothing of it. Until very recently, when a relative asked me to examine their foot and provide them with an X-ray order. The radiologist’s office called me and told me they would not be paid for the x-ray because of a lack in PECOS enrollment Why? Because my Medicare enrollment had lapsed.
This has long term repercussions, because if you are not enrolled in PECOS, Medicare patients cannot obtain Medicare covered services that you order, even if you do not actually perform them and simply prescribe them. This affects both retired providers or those who have simply are fee for service and have opted out of Medicare as a rendering and billing provider.
Fortunately there is an easy fix for this issue. Simply have an enrollment specialist enroll you into PECOS not as a rendering/billing provider (of DME or local Medicare services), but as a Referring/Ordering/Prescribing provider.
By enrolling in this least known category of provider, Medicare beneficiaries you refer for diagnostic testing, DMEPOS or even prescription medication will be covered. That is, the services provided by other Medicare providers will be covered when you a non-rendering provider orders them. Also there is no minimum requirement for claim submission (as you are not eligible to be paid by Medicare) and are merely nationally enrolled into PECOS as a referring/ordering/prescribing provider. The only requirement is that you maintain an active license to practice in at least one Medicare Administrative Contractor’s jurisdiction (MAC). No active board certification nor professional or general liability insurance is required.
To summarize: Keep your I&A access up to date and regularly (twice a year) access this account for review. If there are any changes, update them with the assistance of a professional. Review both your PECOS enrollment regularly. As inspections are ramping up for both local and DME contractors (and there are surprise inspections despite the status of your application) occurring throughout the country, be sure that your PECOS account is kept up to date.
As always, your KevinRoot client services team is willing and able to work with you and refer you to the right professionals for assistance.
- Before you use the actual enrollment portion of PECOS, you must have registered with the Identity and Access Management System (I&A) within PECOS. The changes to the I&A system are simple. One must regularly enter the I&A system using your username/password and PIN. If you have lost/misplaced your password, PIN or username you will need to follow the steps required to restore those to your account.
