PECOS: CMS forges ahead; consultant offers Webinar

Sunday, November 22, 2009

BALTIMORE - Despite requests by AAHomecare and physician groups, CMS mentioned nothing about delaying the Provider Enrollment, Chain and Ownership System (PECOS) registration process during last week's Open Door forum for Physicians, Nurses & Allied Health Professionals.

The forum did, however, offer HME providers an opportunity to ask CMS officials questions about the program, which goes into effect Jan. 4, 2010. After that date, claims for DME will be rejected if the prescribing physician has not registered with PECOS.

AAHomecare estimates that between 20% and 90% of physician (depending on the provider) have not yet registered with PECOS.

During the Nov. 17 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.

In other PECOS news, industry consultant Andrea Stark will hold a Webinar titled "Conquering PECOS: What You Can Do" on Nov. 23 and Nov. 24 at 2 p.m. EST. The Webinar will cover:

*    What the PECOS database is and how it has been developed;

*    Why DME MACs are using PECOS to edit claims;

*    How claims are edited using PECOS;

*    Where to look for rejection/warning messages;

*    How to determine if your physicians are enrolled in PECOS;

*    What tools are available to help you educate your physicians; and

*    What steps can be taken to prevent claim rejections.

For more information on the Webinar, contact