Here's your warning: PECOS edits on way

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Friday, March 1, 2013

BALTIMORE – CMS will kick off phase 2 of the Provider Enrollment, Chain, and Ownership System (PECOS) on May 1, it announced March. 1.

That's the date it will start rejecting claims that contain the names of physicians not enrolled in PECOS. CMS is required to give 60 days notice before the edits take place.

“They have started putting lines in the water with educational pieces and saying they are going to move forward,” said Andrea Stark, a reimbursement consultant with MiraVista. “Once they provide official notice, we will have 60 days before the edits go into place.”

Phase 1 of PECOS, which launched nearly a decade ago, expanded the claims process to include verifying that the ordering/referring physician is eligible to order/refer and is enrolled in Medicare.

With edits on the way, now is the time for providers to clean up their records, said Andrea Stark, a reimbursement consultant with MiraVista. One way to do that: Look for the N544 remark code on explanation of benefits, which indicates that the claim would get denied once Phase 2 goes into effect, Stark says.

“They should be making sure that the spelling in their databases and software billing systems is correct,” she said. “Make sure there’s no transition of the NPI numbers, and that the NPI number is linked to an individual and not linked to a group practice.”

Although, unlike physicians, providers are not required to enroll in PECOS, it’s something they may want to consider, too, stakeholders say.

“We talk about strategies to try to get more providers interested in doing it and the benefits of being able to update your files electronically,” said Rose Schafhauser, executive director of the Midwest Association for Medical Equipment Services. “There’s the fear of the unknown, but those that are proficient in it like it better than the manual system.”

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Comments

If CMS had announced they would deny the doctors' own claims, they all would have enrolled immediately. It is absurd that we suppliers have to hound the doctors and explain PECOS so that our claims don't deny!