PECOS preparation pays off, providers say

Friday, January 24, 2014

WASHINGTON – CMS on Jan. 6 officially began denying claims with the names of physicians not enrolled in PECOS, and providers say so far, so good.

“We’ve been very fortunate,” said Lori Corey, vice president of finance for Waukesha, Wis.-based Oxygen One. “It’s been very smooth.”

This phase of PECOS has been years in the making. There have been numerous delays, most recently from May 1, 2013.

Those delays have been a big help in allowing providers to get doctors up to speed with handouts and other educational efforts, they say.

“We panicked years ago, when they first extended the deadline,” said Dave Mills, co-owner of Chesapeake, Va.-based First Choice in Homecare. “Back then, around 50% of doctors weren’t signed up. When they extended it, we didn’t stop our educational efforts.”

Any issues that have come up have been minor, says provider Chris Rice. 

“Maybe the doctor’s name is spelled wrong—not wrong, but different from what’s in PECOS—minor things like that,” said Rice, CEO of Diamond Respiratory Care in Riverside, Calif.

Another issue: Physicians submitting prescriptions using a group number, rather than an individual number.

Billing expert Peggy Walker says she’s heard of some military physicians refusing to register with PECOS and some DME MACs needing to update some of the information in the system, but that’s about it.

“For most people, this really was less painful than they thought it would be,” said Walker, a billing specialist for The VGM Group’s U.S. Rehab.

Providers say the process of checking to see if a physician is enrolled in PECOS has also been pretty painless, thanks to software vendors stepping up to the plate to flag those physicians in their systems.

“We’ve really had to do nothing; it’s all done by software vendor,” said Paul Reses, co-owner of Pleasantville, N.J.-based Lincoln Medical Supply. “That’s good, because we don’t have time to deal with this—we’ve got a thinned down staff because of thinned down reimbursements.”


We providers may have been well prepared but, even after all the delays, CMS still had problems. Claims have denied in error and must await resolution of the issues.