To PECOS or Not to PECOS!

PECOS is the short form for Provider, Enrollment, Chain, and Ownership System. It is a database where doctors register with the Centers for Medicare and Medicaid Services (CMS). It is a national electronic database for recording and retaining data on Medicare-enrolled providers and suppliers. CMS developed PECOS as a mechanism to combat fraud and abuse.

PECOS was developed by CMS as a result of the Patient Protection and Affordable Care Act. Any physicians who refer or order home healthcare services or supplies are required either to be enrolled in Medicare or have officially opted out – and registered in PECOS as per the regulation. An NPI number is necessary to register in PECOS. A 10 digit numerical identifier for providers of health care services is known as NPI. It is unique to the provider and national in scope.

Necessity of PECOS

Effective January 6, 2014, CMS started to deny claims for Medicare supplies or home health services from all physicians who were not registered in PECOS. The Patient Protection and Affordable Care Act authorizes CMS to decline Medicare home health services or supply claims from physicians not registered in PECOS. Physicians who care for Medicare patients should enroll in PECOS to ensure their patients can receive the supplies and care they need.

Any claims for services or items that have been prescribed will be denied if the physician is not in the PECOS system. This applies only to Medicare claims. Not being in the PECOS system will delay/prevent hospital discharges and will make it difficult for patients to receive the items they need.

When PECOS first became operational, it was used for entering enrollment data on new providers and suppliers; however, data on already enrolled providers and suppliers were not entered into PECOS. That changed with the overhaul of the enrollment rules effective June 2006, when CMS implemented standardized procedures to update and collect enrollment data maintained in PECOS, established sanctions for failing to timely provide updated enrollment data, initiated revalidation requirements, and published revised application forms so that NPI data could be collected. CMS guidance regarding enrollment rules is found in Chapter 10 of the CMS Program Integrity Manual.

How to Enroll for PECOS?

Suppliers and providers have two options for reporting enrollment data when initially enrolling or providing an update to previously reported data —  Internet-based PECOS and paper applications.

The paper versions of the enrollment forms are available on CMS’ website in pdf format which has form fields to allow the forms to be completed electronically. Before submission to the enrollment contractor for processing the forms have to be printed and signed. CMS periodically changes its enrollment forms, and submission of an older enrollment or enrollment update on an incorrect form will lead to rejection of the application, which may delay the effective date for the enrollment or change. Therefore, it is crucial to go visit the CMS website before completing an enrollment application and confirm that the most current application is being completed.

An online alternative to the paper versions for completing enrollment applications is Internet-based PECOS. Authorization to access and complete the applications need to be obtained first, in order to enroll using the online applications. CMS implemented a security system to register users and control the issuance of User IDs, passwords, and access to CMS web-based applications. Individual enrollees (physicians and non-physician practitioners) use the Individuals Authorized Access to the CMS Computer Services (“IACS”) system. Medicare supplier enrollees (group practices and other types of suppliers) use the IACS Provider/Supplier Community (“IACS-PC”) system.

Many enrollees find the paper applications far less time-consuming and cumbersome to complete, especially since the certification still has to be printed and sent via the mail. Even CMS acknowledges that when applications need to be completed in short order, Internet-based PECOS will likely delay the enrollment due to the time to register and obtain access through the security system.

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We are catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders.