Providers Without a PECOS Record Will Receive a Letter From Their Medicare Administrative Contractor (MAC)
Note: MLN Matters published this link on June 9th that was inadvertently left out of the June 8th notice: http://www.cms.gov/MLNMattersArticles/downloads/MM6842.pdf
On May 28, 2010, CMS in Change Request 6842 notified Medicare Part A & B Administrative Contractors (A/B MACs) of their responsibility to facilitate a “One-Time Mailing” to all physicians and non-physicians who are currently enrolled in Medicare but who do not have an enrollment record in PECOS.
This mailing is to take place no later than 30 days after the date of the issuance (May 28th), therefore no later than June 28, 2010, leaving only six business days before the July 6 date for PECOS enrollment.
Additionally, the Change Request states:
A provider education article related to this instruction will be available at http://www.cms.hhs.gov/MLNMattersArticles/ shortly after this CR is released. You will receive notification of the article release via the established “MLN Matters” listserv. Contractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. In addition, the provider education article shall be included in your next regularly scheduled bulletin. Contractors are free to supplement MLN Matters articles with localized information that would benefit their provider community in maintaining Medicare provider enrollment data correctly.
As of Tuesday evening when I posted this article, the MLN Matters article referred to had not been published.
Interestingly, there is no mention of the July 6, 2010 date that is the so-called compliance date for all providers to have an enrollment record in PECOS. As of the last CMS open door forum (my notes here) there was a lack of clarity surrounding the July 6, 2010 date versus the original January 1, 2011 date. The speaker would not definitively say that providers without a PECOS enrollment record as of July 6, 2010 would not receive Medicare payments. Given the short time frame between the MAC letters and the July 6 date, one would assume providers will have a grace period before CMS shuts off reimbursement for services rendered and/or refuses stimulus money for meaningful use of an EMR.
More information on the Stimulus Money here:
FAQ on HITECH, Meaningful Use, Eligible Providers, and the Stimulus Money
ARRA Eligible Providers: Who Is Eligible to Receive Stimulus Money and How Much is Available Per Provider?
If you are not enrolled in PECOS,
this is what your letter will look like:
[Physician/Non-Physician Practitioner Name and Correspondence Address]
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].
[Name of carrier or A/B MAC]
Posted in: Headlines, Medicare & Reimbursement, PECOSLeave a Comment (7) ↓
I heard that doctors ability to bill for their own services will not be affected on July 6, but that doctors not enrolled in PECOS will lose to ability to authorize certain Medicare services – especially home health and medical equipment. Maybe medical testing. The really bad part is that audits by the National Association for Home Care say that 24% to 40% of doctors with active home health patients are not enrolled and therefore not ready to follow their patients’ home health care. This article goes into more detail:
You are correct. Even thought CMS spokespeople have been pretty cagey about their wording, it is clear that Medicare payments for physician/provider services will continue to be made through the end of the year, although there will be bothersome messages on all the EOBs. Services that physicians/providers order are expected to be denied if the ordering/referring physicians/providers do not have a PECOS record. Hopefully, once the letters go out to providers without PECOS records, all the non-enrolled will get enrolled and the crisis will be averted.
Thanks for your comment.
Have these letters gone out yet? We (a large medical facility) have a large number of practitioners who are not yet in PECOS, but as far as I know, none of them have received any correspondence from Medicare confirming the July 6th deadline.
I’m surprised you haven’t gotten letters! Are you sure that your providers aren’t in the ordering/referring list? If they aren’t listed and you haven’t gotten letters, I suggest you call your MAC and try to get an answer one way or another before you start the laborious process of completing the paper enrollment forms.
Let me know what you find out.
I am currently working for a group practice as an MD. All my billing is done through CMS-855R where whatever I bill is sent to the corporation/group. If I decide to open up my own practice down the road, do I update the form to list my new address? The group had applied for medicare provider enrollment for me with the 855I paper form. I don’t have access to the PECOS system but I can make an account. If I am moonlighting for another organization while opening up my office, can I have multiple 855R’s on file to bill several offices at the same time? What is the usual turnaround time for medicare, medi-cal (medicaid in CA), and the various PPO’s?
Here is your answer from our resident NPI Expert, David Zetter:
855R is the Reassignment enrollment application for Medicare. The 855R or if you do this via online enrollment (PECOS) you would always add an additional reassignment. You may have as many reassignments as you like as long as they are current and you intend to bill for services via that physician/entity.
If you already have an NPI, there is no reason for the group to apply for another NPI. YOU DO NOT WANT ANOTHER NPI. This creates more work and possibly more problems for you because you will have to keep this information current and revalidate every five years. Additionally, if you end up not using the NPI, then you have to terminate it. You have access to PECOS via your initial NPI. PECOS uses the same login ID and password as NPPES/NPI, in additional to CMS’ EHR (meaningful use attestation) website.
Yes, again, you may have as many reassignments you need.
There is supposed to be approximately 60 day turnaround time on paper applications and 40 day turnaround on PECOS applications, but there is no guarantee. I know several MACs (Medicare Area Contractors) around the country that are taking up to 120 days to process PECOS enrollments. PECOS will always take precedent over paper applications. State medicaid programs can take 90 days or more. Most commercial insurances will take 30-90 days to process credentialing and contracts. I do not recommend seeing ANY patients of ANY payer until you have received communication of an effective date. Just because you have gone through credentialing and you have a signed contract, does not mean your claims will be paid. All payers have to perform a set-up of your contract into their claims system. This can take 1-2 weeks after a contract is signed and credentialing has been approved.
Additionally, if you have someone doing your credentialing and contracting, ensure they know what they are doing. We have taken over quite a bit of credentialing and contracting across the country because the initial vendor that our clients hired, did not do the job and have delayed and ruined their cash flow. With most payers, you cannot bill retroactively. So, again, do not see any patients until you have an effective date.
David can be reached here:
David J. Zetter, PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC
161 Old Schoolhouse Lane, Suite 3 | Mechanicsburg, PA 17055
Tel: 717-691-7100 | Cell: 717-979-5037 | Fax: 717-691-6855