Some suppliers may be receiving rejection warnings for physicians otherwise identified as enrolled in PECOS. MiraVista recently learned that CEDI’s list of PECOS enrolled physicians is incomplete, which may result in the incorrect firing of warning messages for enrolled physicians. CEDI is aware of the issue and is working to update their records as quickly as possible.

Bottom line, if you are able to match the physician’s NPI and exact spelling of their first and last name in CMS’ list of PECOS enrolled physicians, then they should not result in rejections beginning January 3, 2011. CMS last updated the .csv ordering/referring PECOS file on July 15, 2010.

• Confused about whether your payments will be recouped when PECOS edits are implemented?
• Concerned about billing claims where the ordering physician isn’t listed as enrolled in PECOS yet?
• Worried about the impact PECOS rejections will have on your business?

Due to the increasing number of inquiries MiraVista is receiving regarding the July 6 PECOS physician enrollment deadline and January 3, 2011 rejection implementation date, we have decided to hold a timely PECOS webinar. The majority of the webinar will be held as an open forum for suppliers to ask and receive answers to their PECOS questions directly from DME consultant Andrea Stark.

If you’re ready to get straight answers to your PECOS questions, then this webinar is for you!

We will start with a brief presentation explaining how the PECOS edits will be implemented and covering the latest PECOS updates. The webinar will conclude with an extensive interactive question and answer session.

The webinar will be held on July 29, 2020 at 2:00pm EST. Registration is just $99 per conference line.

Don’t miss out on the chance to get your questions answered! Click Here to be taken to our Seminars/Webinars registration page.

A new PECOS list posted by CMS eliminates almost all of the guesswork when it comes to checking on the status of enrolling physicians. As of July 12, 2010, suppliers can now check to see whether their physicians’ applications are pending contractor review.

CMS has posted two new lists to the Medicare Provider and Supplier Enrollment section of their website: 

• Initial Physician Applications Pending Contractor Review [ZIP, 719KB]
• Initial Non Physician Applications Pending Contractor Review [ZIP, 91KB] 

ClaraVista’s Maureen Bacon was able to confirm with CMS that the lists are exactly as the titles imply; they include the names and NPIs of those physicians and non-physician practitioners whose PECOS applications have been submitted for review.

The publication of these lists follows a recent series of positive breaks for DME suppliers, who are now able to easily identify PECOS enrolled physicians via a frequently updated .csv data file (for more information see CMS Updates CSV PECOS List More Frequently; Twice per Week). Rather than calling a physician’s office directly, suppliers now have an alternate resource to confirm whether a physician has at least submitted their PECOS or CMS-855 enrollment application.

As applications are processed, physicians will be removed from the pending review list and added to the Medicare Ordering and Referring File, which was also updated on July 12, 2010. We expect the two review lists will be updated with the enrollment file simultaneously. As of late, the .csv file is being updated twice per week. You may download the latest version of all three lists by visiting:

http://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp.

We recommend suppliers note the date a physician first appears on the pending review list. If a particular physician’s name remains on the list for an extended period of time, it may be a sign that their Certification Statement has not yet been submitted. At the end of the online enrollment process, physicians are required to print, sign and mail in a paper Certification Statement, and contractors will not process a PECOS application until that statement is received. For physicians whose applications linger on as pending, a phone call may be warranted to confirm whether their Certification Statement was mailed in.

With the establishment of the July 6^th physician enrollment deadline, a recent surge in applications may have contributed to processing back-logs for some contractors.

Recently, MiraVista was contacted by a concerned supplier who found differences between the .csv and .pdf PECOS files they downloaded from CMS. The number of physicians in the .csv version didn’t match those in the .pdf. Naturally, we wanted to know why. So we rolled up our sleeves and did a little digging.

On June 29^th, Maureen Bacon, the controller for our sister billing company ClaraVista, went back to CMS’ website and downloaded the zipped .csv file. As it turns out, CMS modified the file after we first informed you about it on the 24^th. Here’s what we found: 

• The original file that was made available on June 24^th was named OrderReferringJune2010.csv. It was 18.0MB in size, and contained 687,819 lines. (Note: This is the one we first wrote about and is likely the one you downloaded.)
• The file that is now on the site was created by CMS on June 25^th at 8:41am and is named OrderReferring_June2010v2.csv. It is 18.1 MB in size and contains 719,024 lines.

Based on these findings, Bacon sent an inquiry to CMS asking if the .csv file, which now contains an additional 31,205 lines, would continue to be updated more frequently. CMS confirmed that the file will indeed be updated on a regular basis.

“If we don’t have any issues CMS plans to put a new file up twice per week,” wrote one CMS official.

Long story short, it looks like the .csv PECOS file will be updated more frequently than the monthly updates originally scheduled for the .pdf version. To our knowledge, CMS is not yet releasing announcements to let suppliers know each time a new file is posted.

The new .csv Zip file may be downloaded the same way as the previous version, by visiting:

http://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp.

Please be sure to bookmark this site, www.miravistallc.com/blog, and check back regularly for future PECOS news alerts and announcements!

“All I had to do was ask. After a bit of back and forth, they put the PECOS physician list in a .csv format for everyone to download.” – Maureen Bacon, Controller, ClaraVista.

That’s right. Problem solved! CMS has finally uploaded a list of PECOS enrolled physicians in a useable .csv format. Unlike the previous .pdf version, the .csv file will open in Excel or Notepad and can be easily imported into Access. This allows users to quickly sort, filter and search the data with a click of the mouse.

“This is a huge breakthrough,” said Bacon, “We tried to convert the massive .pdf to a .csv file on our own, but even with dual core processors and a T3 internet connection, it proved to be painfully slow and my computer system all but grinded to a halt during the process.”

Bacon said the final straw came after she converted 3,700 of the 13-some-odd-thousand .pdf pages, and then lost it all to a system error.

“I waited 3 hours to get less than a third of the way through and then lost everything,” said Bacon. “I knew I wasn’t the only one having this problem, and I wanted to find a solution that would help us, our billing clients and anyone else who needed a better way to search for physicians in PECOS.”

Thanks to Google and a bit of ingenuity, Bacon located an early transmittal issued by CMS that parsed out responsibilities for implementing the PECOS edits.

“I found a release that contained the names and e-mail address of two of the people put in charge of creating the PECOS file,” said Bacon. “I sent them an e-mail explaining the problems I was having with the .pdf and asked them if they could convert the file into a more user friendly spreadsheet.”

Believe it or not, Bacon received a response just thirty minutes later.

Initially, Bacon was advised to independently convert the .pdf to text or use the search function to look up the physician’s NPI.

“It was clear to me that they didn’t fully understand how long it takes to search 13,000 pages for hundreds of physicians in a .pdf file,” said Bacon. “So I gave them an NPI from the last page and asked them to start at page one and search for it; just so they could see how long it takes for themselves.”

And it looks like that did the trick!

Less than 24 hours after her last correspondence with CMS officials, a new Zip file was posted for download at:

http://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp.

The Zip contains a .csv version of the PECOS file, which lists all 687,819 physicians currently enrolled in the system.

But Bacon doesn’t credit herself alone for the breakthrough.

“I didn’t do this one on my own,” said Bacon. “There have been many people before me, including Medicare contractors and industry organizations, who have asked CMS to put the .pdf in a better format. I guess I just happened to contact the right people at the right time.”

Lucky us.

We’d like to offer a special thanks to CMS for listening to our concerns and being so responsive on this issue.

Good news for DME suppliers struggling to get physicians enrolled in PECOS! CMS has instructed the Part A and Part B MACs to perform a one-time mailing of a PECOS solicitation letter to every physician in their jurisdiction who is enrolled in Medicare, but who isn’t found in the PECOS system. Those physicians who need to establish an enrollment record in PECOS will soon receive a letter directly from their MAC, which provides them with instructions on how to enroll in the system and informs them of the consequences of non-enrollment (i.e. the inability to order or refer services for Medicare beneficiaries).

All solicitation letters must be sent to physicians no later than June 28, 1010. In the event that a letter is returned as undeliverable, CMS has instructed the MAC to place the letter in the physician’s file, but to take no further action otherwise.

A copy of the letter has been pasted below. The full instruction issued to the MACs is located at: http://www.cms.gov/transmittals/downloads/R712OTN.pdf.

Dear Physician/Non-Physician Practitioner:

 

Our records indicate that you do not have an enrollment record in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) because you enrolled in Medicare prior to the implementation of PECOS and you have not submitted any updates to your Medicare enrollment information in the past 6 (or more) years. PECOS is the enrollment system for Medicare providers and suppliers.

 

There are three important reasons why you should take the necessary action to establish an enrollment record in PECOS as soon as possible. First, updating your Medicare enrollment record will assist us in ensuring payment accuracy for the services you furnish to Medicare beneficiaries. Second, you will need an approved enrollment record in PECOS to continue to order or refer items or services for Medicare beneficiaries. Finally, in accordance with the American Recovery and Reinvestment Act of 2009, Title XIII, known as the “HITECH Act,” incentive payments may be made by Medicare and Medicaid to enrolled “eligible professionals” and certain hospitals that meet the HITECH requirements. More information on Medicare HITECH incentive payments can be found at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp under “Related Links Outside CMS” on the CMS web site. The Centers for Medicare & Medicaid Services (CMS) will use the PECOS enrollment records to verify Medicare enrollment for HITECH incentive payments. Therefore, you will not be eligible to receive incentive payments from Medicare for meaningful use of certified electronic health records if your enrollment information is not maintained in PECOS by CMS.

 

Since you do not have a current Medicare enrollment record, it is imperative that you immediately begin the process to establish your enrollment record in PECOS. CMS expects you to do this as soon as possible after receiving this letter. If you have already submitted an enrollment application within the last 60 days, and your enrollment application has been accepted for processing by the carrier or A/B MAC, you need not take any additional actions based on this letter.

 

You can submit your enrollment application in one of two ways:

 

(1) Use Internet-based PECOS  

 

Step 1. Before you begin, be sure you have a National Provider Identifier (NPI) and have created a User ID and password in the National Plan and Provider Enumeration System (NPPES). You will need the NPPES User ID and password in order to access Internet-based PECOS. If you need help creating an NPPES User ID and password, or if you are not sure you ever created them or cannot remember what they are, you may contact the NPI Enumerator for assistance at 1-800-465-3203.

 

Step 2. Read the documents that are available about Internet-based PECOS on the CMS Provider/Supplier Enrollment web page (www.cms.hhs.gov/MedicareProviderSupEnroll).

 

Step 3. Once you have completed and submitted your enrollment application using Internet-based PECOS, be sure to print the Certification Statement, sign and date it, and mail it, along with any required supporting documentation, to the carrier or A/B MAC whose name and mailing address will be displayed to you by the system.  

 

Note: If you reassign some or all of your Medicare benefits to a group practice, there will be two Certification Statements to print, sign and date, and one of them will also need to be signed and dated by an Authorized Official of the group practice. The carrier or A/B MAC cannot process your web-submitted enrollment application without having the signed and dated Certification Statement(s) in hand.

 

(2) Complete the paper Medicare enrollment application (CMS-855I) as an initial application. 

 

Step 1. Complete the CMS-855I (if you reassign benefits to a clinic or group practice other than your own, complete a CMS-855R as well), sign and date (blue ink recommended) and mail the application(s), along with any required additional supporting documentation, to the Medicare carrier or A/B MAC. These forms are downloadable from the CMS Provider/Supplier Enrollment web page (shown above) or the CMS forms page www.cms.hhs.gov/cmsforms, or you may request the necessary forms from the carrier or A/B MAC. 

 

Step 2. Once the paper application has been received by the carrier or A/B MAC, the carrier or A/B MAC will begin to process your enrollment application. If additional information is needed by the carrier or A/B MAC to complete the processing of your enrollment application, they will contact you. 

 

You are strongly urged not to delay in establishing your Medicare enrollment record within PECOS, especially if you plan on applying for incentive payments under the HITECH program. 

 

The carriers and A/B MACs are expected to process your enrollment application within 60 days as long as you submit your enrollment application before September 1, 2010.

 

If you need information about Medicare enrollment or how to use Internet-based PECOS, visit the CMS Provider/Supplier Enrollment web page at:

 www.cms.hhs.gov/MedicareProviderSupEnroll.

 

If you need assistance with your NPPES User ID and password, contact the NPI Enumerator at 1-800-465-3203.

 

If you have questions about this letter, contact [carrier or A/B MAC phone number/contact person].

 

Sincerely,

[Name of carrier or A/B MAC]

 

In an Interim Final Rule released on May 5^th, CMS gave many suppliers a slight panic attack by making July 6, 2010 the proposed deadline for physicians and non-physician practitioners to enroll in PECOS. While this deadline is in accordance with requirements in the Patient Protection and Affordable Care Act, it’s nearly 6 months sooner than the expected start date for PECOS rejections (January 3, 2011) and left many suppliers wondering whether the deadline for claims rejections had changed.

As of now, January 3^rd still stands as the start date for PECOS rejections… CMS has not rescinded CR 6421, which implements the 01/03/11 rejection date, and CEDI has not yet received any direction to begin rejections prior to this date. However, suppliers shouldn’t get too comfortable.  During a May 26th Open Door Forum, Medicare officials who were asked for clarification on when PECOS rejections would start refused to reaffirm the January 3^rd date, stating only that “notifications will be sent out before PECOS edits begin,” and that CMS always reserves the right to retroactively reprocess claims.

At this point, there have been several conflicting news releases from industry publications regarding whether rejections will begin in July 2010 or January 2011. The thing to take away from all of this is that while the official rejection date has not yet changed, suppliers should keep on their toes and prepare themselves for the possibility of an accelerated deadline. The PPACA does list a July deadline for physicians and non-physician practitioners who order DMEPOS to enroll in PECOS; however, CMS’ IFR is not final, and they will be considering supplier comments on the rule prior to issuing final guidance.

What is certain, is that DMEPOS suppliers must include the legal name and NPI of the ordering/referring physician or non-physician practitioner on each claim  effective July 6, 2010. Per CMS, claims that are not in compliance with this requirement after the July deadline may be subject to administrative review.

CMS will be taking comments on the interim final rule until July 6, 2010. Complete details on how provisions within the rule affect DMEPOS suppliers will be included in the June issue of Vista Notes.

The same system that currently allows physician and non-physician practitioners to enroll, reenroll and update their Medicare information online will soon be made available to DME suppliers! During an open door forum call held on May 19^th, CMS announced that DMEPOS suppliers will be given access to Medicare’s online Provider Enrollment Chain and Ownership System (PECOS) by July 13^th of this year; however, they will not be able to fully utilize the system until Fall 2010.

Once the system becomes availalbe in the Fall, suppliers will be able to go online and use PECOS to quickly:

• Submit new enrollment applications,
• Complete the re-enrollment process,
• Track the status of their applications,
• View and make changes to their enrollment records,
• Voluntarily terminate their billing numbers, and
• Reactivate an inactive (but not terminated) billing number.

Suppliers who submit their applications online will notice that PECOS offers a much quicker processing time – just 45-days, versus the 60-day processing time for paper submissions. However, PECOS does not eliminate the need for paperwork entirely. When submitting an application via PECOS, you will be required to print, sign, date and mail a Certification Statement to the NSC. It’s important to do this immediately after submitting your application (no later than 7-days), as the NSC will not process online enrollments until a Certification Statement is received.

Unlike mail sent via the postal service, PECOS also offers suppliers the ability to track their applications. Beginning 15 days after submission, suppliers may log into PECOS and check to see if their application is:

• Submitted – Sent to the NSC,
• In Process – Being reviewed by the NSC,
• Returned for Corrections – Errors have been found and corrections must be made within 30-days,
• Resubmitted – You have made corrections and resubmitted the application, or
• Approved, Denied, or Rejected - Final status.

To prepare for the July 13^th deadline, CMS will begin transferring all enrollment data for active DMEPOS suppliers from the NSC into PECOS on July 5, 2010. Just as with physician enrollments, if your billing number has become inactive, or if you have not enrolled, reenrolled, or made changes to your information since November of 2003, you will not be included in this initial transfer.

After July 13, 2010, you may access PEOCS and check to see if you are listed in the database by visiting https://pecos.cms.hhs.gov/ and logging in with your NPPES user ID and password (these were established when you applied for your NPI). If your information is not found, you will need to update your enrollment record with the NSC and may do this by submitting an online enrollment application via PECOS, or by mailing a paper CMS-855S.

[Note: If you submitted a paper application to the NPI Enumerator and need to establish an online NPPES user ID and password to log into PECOS, you may do so by visiting https://nppes.cms.hhs.gov/NPPES/CreateLoginForExistNPIPage.do. If you have forgotten your NPPES user ID or password you will need to contact the NPI Enumerator at 1-800-465-3203 or customerservice@npienumerator.com.]

For more information on using the PECOS system, see CMS’ Getting Started with PECOS Guide for DMEPOS suppliers, available under Downloads at:

http://www.cms.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp. 

The guide provides: a breakdown of the PECOS enrollment process for individual and organizational providers, step-by-step instructions on how to submit an online enrollment application, information on checking the status of your application, and answers to frequently asked questions.

Effective March 22, 2010, suppliers in NAS Jurisdiction D may verify a physician’s enrollment in PECOS via the Interactive Voice Response (IVR) System. To utilize this new feature, suppliers will need the physician’s NPI, along with their first and last name.

Verifying a physician’s PECOS enrollment via the IVR is a fairly simple process. First, suppliers must call the IVR and select option 7, or say “Provider Enrollment.” Next, they must key-in or state the physician’s NPI and name.

• If stating the physician’s name, say the first name, followed by the last name.
• If keying in the physician’s name, enter the first four letters of the last name, followed by the first letter of the first name.

You do not need to enter any keys for spaces, hyphens, etc. within the name.

The IVR will then indicate whether or not the physician is currently enrolled in Medicare and able to order or refer DME. If the IVR is unable to locate the physician, you may verify that the NPI and spelling of the physician’s name is correct via the NPPES registry. Once this information is confirmed, efforts should be focused on contacting the physician and educating them about Medicare’s PECOS enrollment requirement.

For additional information on verifying physician enrollment in PECOS, see “Find Physicians in PECOS Fast and Free!” and “Searchable PECOS Database now Available to DME Suppliers.”

Please note that with the addition of the PECOS option, some IVR menu options have changed. Please refer to the NAS IVR User Guide for complete details on utilizing the system.