PECOS- from Mobility Management

PECOS- from Mobility Management

Jeremy Sprouse CPO, BOCOP

11/3/2009

This is from Mobility Magazine about PECOS...note, that it can take up to 60
days for Physicians to register. It looks like more delayed payments and
rejections for us in the near future.
<URL Redacted>


PECOS Warnings Are DME Suppliers' Latest Worry
By Laurie WatanabeOct 29, 2009
At the latest CMS Open Door Forum on Oct. 21, the main topic on callers'
minds wasn't the competitive bidding program that had just started taking
bids, but the PECOS warnings newly appearing on large numbers of DME claims.

Starting this month, the Centers for Medicare & Medicaid Services (CMS) is
notifying suppliers whenever a DME claim includes the name of an ordering
physician or non-physician practitioner (e.g., nurse practitioner, clinical
social worker, physician assistant, etc.) who is not currently in Medicare's
Provider Enrollment, Chain & Ownership System (PECOS).

Right now, those notifications, which appear on the claims, are being called
informational messages. During the Open Door Forum, CMS' Jim Bossenmeyer
said the affected claims are still being paid; the informational messages
are intended solely to notify suppliers that the ordering physician or
non-physician practitioner is not enrolled in PECOS.

But come January, claims will be denied if the ordering physician or
non-physician practitioner is still not in PECOS.

The PECOS problem is coming to a head now because CMS only began issuing
those informational messages in October.

Bossenmeyer added that an informational message may also be generated if the
ordering physician's name isn't correct or if the NPI used on the claim was
not the NPI belonging to the individual physician.

CR 6421 requires that a claim coming in from a DMEPOS supplier include the
legal business name -- that would be for example Robert Smith vs. Bob Smith
-- and the individual Entity Type 1 NPI for that physician in the secondary
identifier field, Bossenmeyer said during the Open Door Forum. Currently,
DMEPOS suppliers can either use their NPI number if they're not sure of the
NPI number being used for ordering...as of Oct. 4, DMEPOS suppliers began
receiving informational messages regarding a physician or non-physician
practitioner who did not have an enrollment record with the Medicare program
that has been updated since November of 2003.

In recognizing that many DMEPOS suppliers are receiving these informational
messages, we would ask that the DMEPOS supplier first begin working with
their clearinghouse or their billing agent to, one, be sure that the claim
is coming in with the legal business name and the NPI of the individual
practitioner - that will resolve some issues for the processing. For those
physicians that you continue to receive informational messages on, the
DMEPOS supplier can verify if they choose (to determine whether or not the
physician is in PECOS).

While Bossenmeyer mentioned that suppliers can check PECOS to see if the
physicians they work with are in the system, during the Forum's question and
answer period, callers questioned the system's ease of use and how
accurately that system reports whether physicians are listed or not.

(Click HERE to see the PECOS system.)

In answer to multiple questions from callers, Bossenmeyer strongly,
repeatedly and categorically denied that CMS was currently considering
postponing the date when warnings will become denials.

Bruce Rodman of the National Home Infusion Association was the first caller
in the Q&A session, and he said that association members are reporting that
large numbers of claims contain the non-PECOS warnings. Rodman said those
members are concerned about those warnings turning into rejections in
January.

Rose Schafhauser, executive director for the Midwest Association of Medical
Equipment Services (MAMES), said in a follow-up call with Mobility
Management that the MAMES members she's heard from are reporting 50 to 80
percent of their claims are carrying those warnings.

Schafhauser added that the PECOS registration process can take quite some
time, easily 60 days or more - which means that even if thousands of
physicians began registering in PECOS immediately, they might not meet that
January deadline.

Which is why, Schafhauser says, suppliers are concerned about the PECOS
issue more than you can imagine.

The PECOS system is a database of physicians and non-physician practitioners
enrolled with Medicare; the system is being used in this instance to
determine whether or not physicians who order DME are Medicare-qualified to
do so.

Physicians and practitioners who enrolled to work with Medicare prior to
November 2003 and who have not made changes to their enrollment since then
are probably not in the PECOS system. Those physicians are being asked to
register with PECOS, though several Forum callers insisted that many
physicians are not aware they need to do so, don't understand why they need
to do so, and/or don't feel a sense of urgency to enroll.

During the Forum, Bossenmeyer confirmed that Medicare will continue to pay
physicians' own claims regardless of whether or not the physicians are
registered in PECOS by January



Jeremy Sprouse CPO, BOCOP
Advanced Biomechanical Solutions

                          ********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.

If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>

OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.

Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.