It's full steam ahead for PECOS

Tuesday, November 17, 2009

BALTIMORE – CMS mentioned nothing about delaying the Provider Enrollment, Chain and Ownership System (PECOS) registration process during yesterday’s Open Door forum for Physicians, Nurses & Allied Health Professionals.

But the forum did offer HME providers an opportunity to ask CMS officials questions about the program, which goes into effect Jan. 5, 2010. On that date, claims for DME will be rejected if the prescribing physician has not registered with PECOS.

During Tuesday’s forum, HME providers wanted to know the following:

Question: If we bill a claim and it is rejected because a referring physician is not in PECOS, what type of denial will we get? And if we get the physician to enroll based on the denial, will we be able to resubmit the claim?

Answer: It will be a rejection and not a denial, and the claim can be resubmitted—as long as the enrollment record by the time the claim is received will pass the edit.

Question: Will you provide a link to the PECOS system for supplier organizations so we can check on the status of a physician’s enrollment?

Answer: No. You will not be able to look at the status of somebody’s enrollment record. We’re going to have a list of all the enrolled physicians and non-physician practitioners who can order and refer. If they are not on the list, you are going to get a rejection message.