Act Now to Ensure Your Enrollment in PECOS Database

December 16, 2009

Starting in early October, the Centers for Medicare and Medicaid Services (CMS) began implementing "soft edits" on remittance advice for providers submitting claims, where either they themselves or any listed referring provider are not currently listed in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) database. Eventually, CMS intends to reject claims where the referring and/or ordering physician is not in PECOS.

The Academy signed on to a November 16 American Medical Association letter to CMS urging the agency to withdraw this policy. As a result, CMS announced that it will delay implementation of the policy until April 5, 2010.

This means that you have until April 5, 2010, to enroll providers who order supplies or durable medical equipment (DME) into CMS's online PECOS. Starting January 1, 2010, CMS will issue warnings on all DME claims billed by providers who are not in PECOS.

CMS indicates that an entity can contact the A/B MAC agent or go online to PECOS to view the enrollment record for the facility. For providers who have not revalidated their information since November 2003 (even if no info has changed), these providers will need to submit an initial enrollment application either through PECOS itself or by using CMS-855 paper.

Visit the CMS' PECOS website for further information.

The two transmittals governing the new policy can be found below:

• Transmittal 6417
• Transmittal 6421

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