Providers can't get no satisfaction on PECOS

Thursday, January 21, 2010

BALTIMORE – CMS reported during Wednesday's Open Door Forum that it is working to ensure physicians and other referring practitioners update their PECOS enrollment information, but that did little to reassure anxious providers.

CMS recently added NPI numbers to the PECOS records of about 220 qualified Medicare practitioners and will post that information on its Web site,, in the next few weeks. The file will be updated monthly.

"We do know that since we added those NPIs, the number of informational messages has gone down," said CMS official Pat Peyton.

Providers were skeptical of her claim. Several callers said they had not seen a decrease in the number of messages.

CMS reiterated providers' responsibility to ensure the correct information was being entered.

"It will vary from provider to provider," said CMS official Joel Kaiser, "but nationally, we've seen a decrease. We would encourage all DMEPOS suppliers to work with their clearinghouses and billing centers to ensure that the clearinghouses and billing centers are entering the legal name and the type 1 NPI."

Kaiser also told listeners that CMS will continue to work with the physicians to have them update their enrollment applications

"We will continue to monitor this very closely," he said.

One provider, Cary Jenright from Alabama, asked what options he had when dealing with a patient who has a prescription from a physician not registered with PECOS.

"Do I have an advance beneficiary notice (ABN) option? Do I have a cash option? Can I not provide service to this patient because she went to a doctor who is not enrolled in PECOS?" he asked.

Kaiser said he would look into that and get back to providers at the next Open Door Forum.

At the crux of the problem say providers, is that physicians have no real incentive to enroll.

"I don't have control over my physicians, and many of them are more interested in their own benefits than mine," said Jenright. "Their question to me is, 'Will MY claims deny,' and I have to say, 'Honestly, no, but mine will.'"

What physicians need are real consequences if they fail to enroll, say providers.

"Wouldn't the easiest way to get physicians to comply with PECOs be to stop their Medicare payments?" asked one caller. "I think I speak for suppliers when I ask that question."