BALTIMORE – Coming off last week’s confusing Open Door Forum, HME News called Jim Bossenmeyer, director for the division of provider and supplier enrollment at CMS, for clarification on the Provider Enrollment, Chain and Ownership System (PECOS). For more information and the entire article please click here PECOS
BALTIMORE – CMS officials aren’t cutting HME providers any slack when it comes to complying with the July 6 deadline for the Provider Enrollment, Chain and Ownership System (PECOS). HME providers who take Medicare referrals on or after July 6 from physicians not enrolled in PECOS risk having those claims rejected, CMS officials stated during last week’s Open Door Forum. For more information, please click here PECOS Grace Period
As stated in the CMS provider listserv messages that were sent last fall concerning CRs 6417 and 6421, CMS has made available in the Downloads section of this web site a file that contains the National Provider Identifier (NPI) and the name (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is legally eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in PECOS). This is a .pdf file containing approximately 800,000 records.
A new file will be made available periodically that will replace the posted file; at any given time, only one file (the most recent) will be available. The file can be downloaded by users with technical expertise and further sorted or manipulated. It can also be used to search for a particular physician or non-physician practitioner by NPI or by name. Please note the following: (1) Records are in alphabetical order based on the surname of the physician or non-physician practitioner. (2) Name suffixes (e.g., Jr.), if they exist, are not displayed. (3) There are no “duplicates” in the file. Many physicians or non-physician practitioners share the same first and last name; their corresponding NPIs are the assurance of uniqueness. (4) Deceased physicians and non-physician practitioners are not included in the file.
Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and also contains the physician/non-physician practitioner’s National Provider Identifier (NPI). Under Phase 2 of the above referenced CRs, a physician or non-physician practitioner who orders or refers and who does not have a current enrollment record that contains the NPI will cause the claim submitted by the Part B provider/supplier who furnished the ordered or referred item or service to be rejected.
CMS continues to urge physicians and non-physician practitioners who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003 to update their enrollment record now. If these physicians and non-physician practitioners have no changes to their enrollment data, they need to submit an initial enrollment application which will establish a current enrollment record in PECOS.
For more information, please click above on the title of this post, then click the link For Additional Information
Dear Valued DJO Customer,
Although Medicare has launched an awareness campaign regarding PECOS to the provider community, we have found that many of our customers are unaware of this initiative. Therefore, we are providing this information directly to our DJO customers as a service to you.