PECOS
NCAMES Member, RSI Offers PECOS Help
Reimbursement Services, Inc. (RSI), an NCAMES Associate Member and Bronze Sponsor has released an enhanced PECOS database search utility. The RSI PECOS Database Search Utility is a software program that allows providers to search for individual physicians and also allows the search of an entire list of physicians at once. This is an important feature for providers who need to search for hundreds of physicians. The RSI utility is the only one that provides this feature. The utility is available free of charge but registration is required and registration is limited to one per company.
Follow this link for the full press release: www.hmebillingsolutions.com/mydocuments/pecosutilityrelease.pdf
Free online demonstrations will be available in the next few days. More information is available at the HME Billing Solutions web site www.hmebillingsolutions.com
If you have any questions, please contact:
Brent Mattox, President
Reimbursement Services, Inc.
Greer, SC
864-877-5600
brent@hmebillingsolutions.com
CMS Announcement
CMS announced the delay of implementation of new rules surrounding front-end rejection of claims for DMEPOS based on ordering/referring physician enrollment in the Provider Enrollment, Chain and Ownership System (PECOS) database until April 5, 2010. AAHomecare sent the letter below to CMS last week expressing the Association’s concerns and requesting and immediate delay in implementation of the edits on DME claims. A copy of the CMS transmittal announcing the delay can be found in the link below.
Click here for AAHomecare Leter to CMS regarding Pecos Edits for DEMPOS
Click here for CMS Message regarding PECOS CRs 6417 6421
VGM Shares Info
NCAMES knows that you continue to be concerned about PECOS! VGM has shared this information with state associations for your use. If you have any questions after reading the documents below, please contact Beth at ncames@nc.rr.com.
Updates from VGM
Sample Physicians Letter
CMS Responds to PECOS Warning Edits
Click here for CMS Response
Provider Enrollment, Chain and Ownership System (PECOS) and its affects on DME
What is it?
PECOS is an Internet-based Medicare provider enrollment process, known as Internet-based Provider Enrollment, Chain and Ownership System (PECOS).
Internet-based PECOS is available to physicians, non-physician practitioners, and provider and supplier organizations in all States and the District of Columbia. Internet-based PECOS will allow physicians, non-physician practitioners, and provider and supplier organizations the option of enrolling, making a change in their Medicare enrollment information, viewing Medicare enrollment information, or tracking the status of their Medicare enrollment applications
PECOS is applicable to Part A and Part B providers
How does this affect DME?
Any physician who has not updated their provider enrollment since 2003 must update their application on PECOS. PECOS allows them the “option” of enrolling, and making changes/updates to their information. All physicians are required to re enroll by January 4, 2010.
How do they enroll?
They enroll by going to http://www.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS and following the instructions. They will need their NPPES user ID and password.
Then what happens?
The enrollment is processed by the local AB –MAC. However, the MAC may not complete the enrollments until 60 days.
What is the problem?
If a physician has not enrolled by January 4, 2010 and a DME supplier receives an order from this physician, the supplier will not receive payment for the items billed. The claim will be denied due to “NPI invalid”.
What should we do?
1. Check the NPI and make sure you have it correct
2. Make sure you have correct “LEGAL” name (Robert instead of Bob etc.)
3. Check this site: http://www.medicare.gov/Physician/Search/chooseprovider.asp
If the physician is not enrolled notify him/her and the patient.
An ABN may be used if the physician refuses to enroll.
Also…
EDUCATE physicians and other practitioners! Many are not aware that it does affect them. In simple terms, if we do not educate our referral sources we will not get paid. You can utilize the memo received from your local DME MAC, MLN Article MM 6421. Click here to view. Or use this link: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6421.pdf We suggest you compile a schedule of the physicians and practitioners who have reenrolled. Keep it updated to match the information you already have. Start educating your beneficiaries (and don’t forget
about existing capped rentals) and suggest to them they may be responsible for their payments if their physicians do not reenroll!
Where are we now?
EDI indicates they have had 300,000 edits hit the first day. This may very well be a real problem.
Information provided by Peggy Walker, VGM Billing
If you have any questions, please call Peggy Walker at 800-401-3643.
Click here for additional PECOS information from CMS
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