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!