Provider Enrollment, Chain and Ownership System (PECOS)
Physicians must have a record in the Medicare PECOS database by July 6, 2010, as stipulated in the Patient Protection and Affordable Care Act (PPACA). This provision was included to better track physicians and ultimately reduce fraud and abuse in Medicare. However, many physicians need to enroll, re-enroll or officially opt-out of PECOS to be compliant with this rule. If a physician is not enrolled correctly or has not officially opted-out then home health providers may see their claims denied in the future. CMS is not clear when it will start denying claims from home health agencies whose referring physician is not properly on record with PECOS. VNAA encourages members to identify which of their referring physicians are not currently in PECOS (see physician matching tools below) and to contact your physicians and inform them of this provision.
CMS Delays Rejecting Claims for Home Health Providers - June 30, 2010
VNAA Comments on CMS Physician Enrollment Requirement - June 29, 2010
Physician Enrollment in PECOS
Sample Letter to Physicians (members-only)
This pre-written letter can be customized and given to physicians you work with frequently to alert them of the July 6, 2010, Medicare enrollment deadline for order/referring physicians.
Instructions on How to Match Your Referring Physicians and PECOS (members-only)
Sample Matched Spreadsheet (members-only)
Background on PECOS (members-only) -
Includes physician enrollment requirements, new requirements for home health agencies when submitting claims and major concerns with the physician enrollment process.
(VNAA Member Update e-newsletter article - June 28, 2010)
External Links of Interest
Ordering and Referring Report -
Physicians and non-physician practitioners who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003, CMS is encouraging them to update their enrollment record now.
CMS Medicare Enrollment Website -
Information for providers, physicians, non-physicans practitioners and other suppliers on Medicare provider and supplier enrollment. This includes PECOS, DMEPOS Accreditation, Advanced Diagnostic Imaging Accreditation, etc.
American Medical Association -
Learn more about the Medicare Enrollment process.
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