PECOS Enrollment Process

Enrolling Medicare Providers Online – PECOS Enrollment Presented by David J. Zetter, PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC

No copyright claimed on government material or information.

Takeaways
Step-by-step instruction with screenshots from actual online applications used to successfully enroll providers that you can apply to your own practice.
Understand timelines for accurately submitting supporting documents you need to get your application approved.
Learn the differences between paper-based and Web-based enrollment applications.
Learn how to avoid common mistakes and pitfalls that will stop your application cold.
Retain a complete review of the process to assist in completing an online enrollment yourself

PECOS
Provider Enrollment, Chain, and Ownership System (PECOS)
PECOS supports the Medicare provider and supplier enrollment process by capturing provider/supplier information from the CMS-855 family of forms.
The system manages, tracks, and validates enrollment data collected in both paper form and electronically via the Internet.

PECOS
Medicare has encouraged physicians to update their provider files since 2006. However, it has never impacted the payment of claims for referred items or services.
October of 2009 - first phase of the system was implemented
Under the first phase claims are being paid, but with a warning that the provider is not in the PECOS system.
The second phase was to begin on January 4, 2010. At that time claims for items referred by physicians who are not in the system will deny.
This was delayed again April 5, 2010 and recently, CMS decided to delay again until January 3, 2011, the implementation of Phase 2 of Change Request (CR) 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)) and CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)). CRs 6417 and 6421 are applicable to Part B claims only

PECOS
What happens if I do not register? Beginning January 3, 2011 any claims for items or services that you have prescribed will be denied if you are not in the PECOS system. This applies to Medicare claims only. Not being in the PECOS system will make it difficult for your patients to receive the items they need and will prevent / delay hospital discharges. NOTE: You may have previously prescribed items that are being rented. These items can go back three years or more (oxygen for example). These claims will also deny if you are not registered with PECOS. http://www.cms.hhs.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp#TopOfPage

PECOS
What happens if I do not register? Update.
Physician and non-physician practitioners who order or refer must be enrolled in the Medicare PECOS and must be of the types/specialties that are eligible to order/refer services for Medicare beneficiaries Effective January 3, 2011.
CMS will delay, until January 3, 2011, the implementation of Phase 2 of Change Request (CR) 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)) and CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)). CRs 6417 and 6421 are applicable to Part B claims only.
The delay in implementing Phase 2 of these CRs will give physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers sufficient time to enroll in Medicare or take the action necessary to establish a current enrollment record in Medicare prior to Phase 2 implementation.
Sources: Transmittal 572, CR 6417 dated October 2, 2009; Transmittal 480, CR 6421 dated April 24, 2009

Prior Preparation
There are four basic steps to completing an Internet-based PECOS Web Enrollment Application :
Must have an NPPES User ID and password.
Go to https://pecos.cms.hhs.gov and complete, review, and submit the electronic enrollment application.
Provider availability to sign-off on all submitted documents
Print, sign, and date the two-page Certification Statement and mail the Certification and all required supporting paper documentation to Medicare Area Contractor (MAC) within seven days of electronic submission.
Note: Failure to submit the original, signed Certification and all required supporting documentation will result in the application being rejected.

Tips for Completing / Submitting via PECOS Web
If your enrollment occurred prior to 2003 and no updates/changes have been submitted since 2003, then a complete initial enrollment application must be submitted, either via PECOS web or the paper CMS-855 process.
An original signed, dated Certification Statement and ALL supporting documentation must be submitted to MAC within 7 days of the submission of the electronic application.

Statement and all supporting paper documentation to the Medicare contractor within 7 days of the electronic submission.
Note: A Medicare contractor will not process an Internet enrollment application without the signed and dated 2-page Certification Statement and the required supporting documentation.
In addition, the effective date of filing an enrollment application is the date the Medicare contractor receives the signed 2-page Certification Statement that is associated with the internet submission.
The 2-page Certification Statement must be signed by the physician or non-physician practitioner enrolling or making changes to enrollment information. Signatures must be original and in ink (blue ink recommended). Copied or stamped signatures will not be accepted.

Since Internet-based PECOS is a scenario-driven process, you will only see the enrollment screens necessary to complete your initial enrollment or your change of information action. The information collected using the Internet-based PECOS enrollment process is the same as the information collected through the paper application submission process.
It takes approximately 20 minutes to complete an enrollment application via Internet-based PECOS.

Medicare Online Enrollment
PECOS initial splash page
https://pecos.cms.hhs.gov/pecos/login.do

PECOS Login page
Same username and password as NPPES

Welcome page after login

New application OR
List of previous applications

Questionnaire on type of application
Sole Owner, Self-Employed, Group Member, Group Member and Self-Employed

Questionnaire
Some information may be propagated from NPI data file
Verify everything for accuracy OR enter information needed
Doe John 123-45-6789 08/25/1962

Questionnaire
Some information may be propagated from NPI data file
Verify everything for accuracy OR enter information needed
Doe John 123-45-6789 11/15/1962

Questionnaire
Some information will be propagated from NPI data file
Verify everything for accuracy
Internal Medicine

Questionnaire
Verification that group is also enrolled in Medicare

Questionnaire
Confirmation of reason for application

Initial Enrollment Application
Topic Summary
Add Information

Personal information
Other Name(s)

Personal Information
DEA Number

Birth Information

Medical/Professional School Information
Select Medical School 2002

Topic Summary

Topic Summary
Practitioner Specialty

License & Certification Information

Correspondence Address

Correspondence Contact Information

Correspondence Address (Foreign)

Residency/Fellowship Status

Primary Medicare Services Rendered

Secondary Specialties

Physician Assistant Employment Arrangement

Clinical Psychology Degree

Psychologist Billing Questions

PT & OT Questions

Skilled Nursing Facility Address

Adverse Legal Actions

PA/PC/LLC Information

PAR Status

PA/PC/LLC Adverse Legal Actions

Reassignment of Benefits

Accept Reassignment

Delete Existing Information on Reassignment

Physical Location / Payments Address

Start Date at Practice Location Medical Practice, LLC 123 Main Street Emerald City 12345 6789

Address Verification

Physical Location and Special Payments

Physical Location and Special Payments
(555) 555-5555 Failure to follow these instructions will result in delay in moving through application. Some e-mail addresses can be considered invalid and will require that you enter a different e-mail address.

CLIA Information

FDA Information

Practice Location Type

Special Payments Address
Date You Begin Receiving Payment At This Location

Topic Summary – Physical Location &Special Payments Address
John Doe, M.D. 123 Main Street Emerald City, NY 12345 123 Main Street Emerald City, NY 12345

Northern Emerald City Hospital

Topic Summary – Services at Patient’s Home

Location Information – Services at Patient’s Home

Deleting Information – Services at Patient’s Home

Topic Summary – Patient Records Storage Location

Patient Records Storage Location

Topic Summary – Patient Records Storage Location

Topic Summary – Individuals with Managing Control

Individuals with Ownership/Managing Control

Individuals with Ownership/Managing Control – Adverse Legal Actions

Individuals with Ownership/Managing Control

Billing Agency

Billing Agency - Foreign

Billing Agency

Billing Agency - Foreign

Billing Agency

Topic Summary – Contact Person (regarding this application)

Topics for this Enrollment

Application is now complete
Topics that were completed
Practice Information
PAR Status Information
Physical Location and “Special Payments” Address
Reassignment
Resident/Fellow Status
License and Certification Information
Contact Person

Drop Down Topics
Determine area of application to work on
Very similar to paper 855 forms
Stop process and login in later to start where you left off

Medical/Professional School

Recap and Review Topic Summary

Practitioner Specialty

Par Status/Accept Assignment

Physician Location & Payment Address

NPI

Edit or Enter Multiple NPIs

855R Information automatically linked to 855B/855I in online process

Effective Date, Legal Business Name, Tax ID, Type 2 NPI

Topic Summary & Review

Residency/Fellowship Status

Country, Address, City, State, Zip

Telephone, Fax, E-mail

State License & Certification Information

Issuing State, Effective & Expiration/Renewal Date

Review and Enter Additional Information if needed

Contact/Credentialing Person
Possibilities other than provider

Address

Telephone, Fax & E-mail

Topic List Review
Completed Topics

View & Print Application(s) – 855R
Print Hardcopy or Adobe digital files for records

View & Print Application(s) and Reassignment(s)

View & Print Application(s) - 855I

View & Print Application(s) – 855R

Submission Process
6 Steps

Submission Process
Step 1
Error Check

Submission Process
Step 2
Select Fee-For-Service Contractor

Submission Process
Step 3
Signatures for Adding a Reassignment

Submission Process
Step 3
Signatures for Individual Enrollment

Submission Process
Step 4
Printing and Mailing Instructions

Submission Process
Step 4
Print Certificate Statement

Submission Process
Step 4
Print Authorization Statement for Reassignment

Submission Process
Step 4
Print and/or Prepare Supporting Documentation

Submission Process
Step 4
Print Participating Provider Agreement and Fill Out

Submission Process
Step 5
Submit

Submission Process
Step 6
Print and Retain Receipt of Submission

Submission Process
Notification to contact person

Submission Process
Approval

Follow-up Submission Process
Check status on PECOS
Calls to Contractor Provider Enrollment Department
Squeaky wheel gets the oil and gets the job done FASTER!
Resulting E-mail to Contact Person (example)
Check status on PECOS
Submit
In-Process
Approved, Denied, Etc.
Await Welcome Letter or Follow-up on Further Instructions
Welcome Letter in about 1-2 weeks
Medicare Provider Number NOT on PECOS website
Still a paper process

For More Information or Questions
David J. Zetter,
PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC
717.691.7100
[email_address]
www.zetter.com
www.nschbc.org

PECOS Enrollment Process

by djzetter on Jul 02, 2010

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PECOS Enrollment Process — Presentation Transcript

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