May 13, 2010
We received the following from the RBMA Listserv:
Forget January 3, 2011! PECOS Date Moved 6 Months Closer – Referring & Supplying Providers New Date is July 6, 2010
Physicians and “eligible” providers received a jolt today in the May 5, 2010 Federal Register as the date for enrollment in PECOS was moved up (pending the comment period and any changes resulting from the comment period) six months for providers that order or supply durable medical equipment (DME) for Medicare patients. Instead of the January 3, 2011 date previously announced by CMS, the Patient Protection and Affordable Care Act (Affordable Care Act or PPACA) has provisions to move the go-date to July 6, 2010, just 60 days away.What does this mean to you? Unless something changes based on public comments, beginning July 6, 2010:
- Providers with a National Provider Identifier (NPI) must include it on their Medicare and Medicaid enrollment applications and claims.
- Providers of medical items/other items/services and suppliers that qualify for a National Provider Identifier (NPI) must include their NPI on all applications to enroll in the Medicare and Medicaid programs AND on all claims for payment submitted under the Medicare and Medicaid programs.
- The ordering/referring supplier must be a physician or an eligible professional with an approved enrollment record in the Provider Enrollment Chain and Ownership System (PECOS) thus changing the previously reported January 3, 2011 date given by CMS.
- Claims that do not meet these requirements will be rejected by Medicare contractors.
DME clients may want to dial in to the CMS PECOS Open Door Forum on Wednesday, May 19. Details…
What does “Pending” in the system mean? Does this mean the physician enrolled and has not been evaluated yet?
“Pending” in PECOS for someone who just enrolled means the application data has not been reviewed and approved. If you have specific questions, I recommend you contact your carrier.
Re: PECOS Does this require completion of the Medicare Form 855r? If so, how is section 1 to be completed if the provider has been a Medicare provider, with their practice for more than 6 years, and is not reassigning benefits?
Typically the provider enrolls in the PECOS system with the same information as on paper previously. If the provider is not reassigning benefits to a practice or other institute to bill, then no 885r should be completed. The assumption then is the provider is billing and collecting under his/her own provider number and is not associated with a group. If the provider is a part of a group practice, then my suggestion is that you do re-assign benefits to the group and bill all of your providers under the group number. What you essentially need to do is submit a change of information on the provider’s 855i form for any updated information and also submit an 855r form to re-assign benefits of the provider to the practice. I suggest you take a look at the practice’s information on the PECOS system as well and assure that is up-to-date and correct on the 855b.
I hope this has helped with your question.