Funding Focus

PECOS ...

Brought to You by CMS

• By Kelly Riley
• Jan 01, 2010

January 2010 brings a new challenge for HME providers as they see their valid Medicare claims denied because their referral source enrollment is not compliant with the latest CMS requirement: PECOS enrollment.

The Provider Enrollment Chain and Ownership System, or PECOS, is an Internet-based Medicare enrollment now available to provider and supplier organizations. The Internetbased PECOS is already available to physicians and nonphysician practitioners in all 50 states and the District of Columbia. At this time, PECOS enrollment is not available to DMEPOS Providers.

By submitting an initial Medicare enrollment application through Internet-based PECOS, physicians and non-physician practitioners can have their enrollment applications processed as much as 50 percent faster than if they submitted paper. This means that it will take less time to enroll or make a change in an existing enrollment record.

PECOS meets all required government security standards in terms of data entry, data transmission, and the electronic storage of Medicare enrollment information. Only individuals whose identities have been verified by CMS and who have been approved by a provider or supplier organization’s Authorized Official (AO) may use Internet-based PECOS on behalf of that provider or supplier organization. By safeguarding their user IDs and passwords, PECOS users will be taking an important step in protecting the provider or supplier organization’s Medicare enrollment information.

PECOS is a scenario-driven application process with frontend editing capabilities and built-in help screens. The scenario-driven application process ensures that provider and supplier organizations complete and submit only the information necessary to facilitate the action they wish to take.

How to Set It Up

There are several steps that must be completed before a provider or supplier organization can use Internet-based PECOS. These steps are described in detail in the document entitled, “Getting Started with Internet-based Provider Enrollment, Chain and Ownership System (PECOS)” at www.cms.hhs.gov/-MedicareProviderSupEnroll.

Step One: Set up your company AO.
The Authorized Official of the provider or supplier organization needs to:

• Go to the Internet-based PECOS at https://pecos.cms.hhs.gov to register in the PECOS Identification and Authentication system (PECOS I&A).
• Create a PECOS user ID and password.
• Provide the requested information to CMS. The CMS External User Services (EUS) Help Desk will verify the furnished information.

Step Two: Set up the PECOS user(s).
The AO helps approve individuals who will use Internet-based PECOS on behalf of the provider or supplier organization. Such individuals need to:

• Register in the PECOS Identification and Authentication system.
• Create a Pecos User ID/password.
• Provide information to CMS.

Individuals will receive a systemgenerated e-mail indicating the status of the request. Those approved are considered PECOS users.

How to Use It

PECOS users should visit the Medicare provider enrollment website to download and read the documents relating to Internet-based PECOS. They must log onto Internet-based PECOS to complete, review, and submit the Medicare enrollment application. Internet-based PECOS will guide the user through this process. (Internet-based PECOS enables the user to print a copy of the application.)

The AO must mail the signed and dated Certification Statement, with any supporting documentation, to the designated Medicare contractor. The Medicare contractor will not begin processing the application that was submitted over the Internet until it has received signed and dated Certification Statement.

PECOS Challenges

At the time of this writing, many HME providers have realized that a large percentage of their referral sources have not registered with PECOS. Reports indicate that at the time of announcing this requirement, more than half of providers’ referral sources had not yet registered. Therefore, the first challenge to the HME provider is in finding out which physicians are not currently enrolled in the program.

To assist with this issue, ClaraVista, LLC / MiraVista, LLC, DME industry consultants, have created a simple extractor tool that can be used to identify the physicians who are not enrolled in PECOS. The consultants are sharing this valuable tool with the DME/HME community for free. To access ClaraVista, LLC/MiraVista, LLC’s PECOS Extractor Tool, go to http://www.miravistallc.com/blog/?p=768.

Another challenge has been in helping to educate and urge physicians to register. Some providers are enlisting beneficiaries’ support in this effort. In the meantime, HME providers must keep track of regulatory changes such as these to stay afloat. Hopefully, this bit of information will assist providers in their efforts to educate the physician community on how their performance impacts providers’ livelihoods.

This article originally appeared in the Respiratory & Sleep Management January 2010 issue of HME Business.