PECOS Delayed until Further Notice

December 7, 2010

The Centers for Medicare & Medicaid Services (CMS) recently announced that it has delayed the effective date of their Internet-based Provider Enrollment, Chain and Ownership System (PECOS) that was scheduled to take effect January 3, 2011.

This was introduced as “the next best thing” to help you with reimbursement. The CMS Web site states the Advantages of Internet-based Pecos are as follows:

  • Faster than paper-based enrollment (45 day process time in most cases, vs. 60 days for paper)
  • Tailored application process means you only supply information relevant to your application
  • Gives you more control over your enrollment information, including reassignments
  • Easy to check and update your information for accuracy
  • Less staff time and administrative costs to complete and submit enrollment to Medicare

I do not doubt this system will do all of the above, just be aware of a “wolf in sheep’s clothing.” The underlying motive is the bottom line of CMS. They are looking to save money first on overhead and second through rejecting your claims.

Profit is not a four letter word

CMS is out to make a profit just like you and I and every other business worldwide. The key is to make sure that their profit is not cutting into your profit.

In an article posted on the College of American Pathology(CAP) Web site, February 2010, titled “Don’t Delay: Help Referring Physicians Register in CMS’s PECOS – Not Doing So Could Stop Your CMS Payments.” The article states “The Centers for Medicare & Medicaid Services (CMS) ordered Medicare Administrative Contractors (MACS) and carriers to issue warnings – and in the future to stop paying for services – when the service’s referring physician’s National Provider Identifier (NPI) and the first and last name are not in CMS’s Provider Enrollment, Chain and Ownership System (PECOS).” Go to www.cap.org to view the complete article.

Bottom line amounts to this… if you and any referring physician are not registered, you will not get paid.

Originally, CMS was scheduled to stop paying claims back in January 2010. Since then, they have twice delayed the rule to take effect on January 3, 2011. Most recently, they have delayed the deadline again with no target date at this time. Contractors and carriers have been told to continue to process claims and if the claim fails the edits, to send out the warnings stating payment will stop.

If you do not want to lose income, you will need to do some footwork to reassure you and your referring physicians are enrolled in Medicare’s PECOS system. CAP has posted a Sample Letter to Referring Physicians for your convenience; go to www.cap.org to review the letter.

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