Thursday, 11 February 2016

PECOS Delayed Again

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Released 7/7/10

CMS Pushes Back PECOS Date to Fall but Policy Implications Still Unclear
Today in an Open Door Forum, CMS announced that it will delay “until the fall” enrollment in the Internet-based Provider Enrollment, Chain and Ownership System (PECOS).  CMS had previously stated that the deadline was July 6, 2010.  However, after questions posed to CMS on the call today from AAHomecare VP for Government Affairs Walt Gorski, it was still unclear whether HME providers could be subject to recoupment if referring providers are not in the PECOS system.  The Association continues to press CMS for clear and unambiguous guidance and is working with providers and patient groups to address our concerns.


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Released: 6/30/2010

Medicare Working with Ordering and Referring Providers and Suppliers to Streamline Enrollment Process

The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain and Ownership System (PECOS) to ensure that Medicare beneficiaries continue to receive the health care services and items they need.  PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.

As part of those efforts, CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010.   While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems.  CMS is continuing to update and streamline the process, and more providers have been enrolled in the past few days.

CMS issued an interim final regulation on May 5, 2010 implementing provisions of the Affordable Care Act that permit only a Medicare enrolled physician or eligible professional to certify or order  home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) , and certain items and services under Medicare Part B.  The new law applies to orders, referrals and certifications made on or after July 1.  The comment period for the regulation closes on July 6, after which the comments will be reviewed and considered before a final regulation is issued.

The Affordable Care Act provisions and the regulation were designed as steps to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.

Many physicians and other providers and suppliers have continued to make good faith efforts to comply with the requirements of the law and regulation.  These efforts will be a significant factor in determining the procedures and processes that will be incorporated in the final rule.

While the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS.  However, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid.

Additionally, though CMS is taking a more deliberative approach to using the PECOS enrollment system, the agency will employ a contingency plan to meet the ACA requirement that written orders and certifications are only issued by eligible professionals effective July 1.

CMS will continue to send informational notices to providers reminding them of the need to submit or update their enrollment and will work with the provider community to provide guidance on enrollment and will process all applications expeditiously.

CMS to Enforce Accreditation on Claims as July 6 2010

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Medicare PECOS hasn’t received that much attention since it was delayed (as we thought) to January 2011. However, over the last week or so there has been a flurry of information that was sparked with announcements made on a CMS conference call regarding CMS PECOS program.

Now, we’re learning that effective 7/6/10 CMS will begin to verify that the provider is accredited to provide the item on the claim. If accreditation for that product category is not on file, the claim will be rejected by the Medicare PECOS system.

The following is an excerpt from the Medlearn Matter on the topic. The link below will take you to the version of the article.

Best regards,


Effective July 6, 2010 Centers of Medicare and Medicaid Services (CMS) will implement edits that will result in Medicare Claim denials for HCPCS codes that are associated will supplier categories included in your Accreditation. See verbiage from Medicare Learning Network Matters (MLN Matters) 6566 below:

“Edits for the Healthcare Common Procedure Coding System (HCPCS) codes in the product categories designated by MIPPA as requiring accreditation will be in effect. Effective for claims with dates of service on or after July 6, 2010, this Medicare systems edit will automatically deny claims for these codes unless:
1.      The DMEPOS supplier has been identified as accredited for the timeframe that covers the date of service on the claim; or
2.      The DMEPOS supplier is currently exempt from meeting the accreditation requirements.” 

Click here for the Medlean matter (MLN) article on Medicare PECOS change.

PECOS Delayed again - now 1/3/11

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CMS announced today that the implementation of the PECOS program will be delayed until 1/3/11.   The site will be updated shortly... Stay tuned.

PECOS Physician List Released

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PECOS List Released

This afternoon CMS released the list of physicians enrolled on PECOS. They released the information as a Adobe Acrobat (PDF) file.


The file is over 13,000 pages and contains over 800,000 records. You’re supposed to use the CRTL-F (Find / Search) function of Acrobat to find the record you’re looking for… It’s a very slow process.



There are only 3 fields to this report... First name, last name and NPI. There is no state or any other way to sort the data (wow...).