PECOS Edits Delayed - But Enroll Now

January 14, 2011

CMS has plans to implement changes to Medicare’s Provider Enrollment, Chain and Ownership Systems (PECOS), which is used to enroll physicians into Medicare. Under the impending changes, CMS will deny claims for services ordered or referred by a physician who doesn’t have a PECOS file. That, of course, means no payment.

You’ve probably heard about PECOS - more specifically, that if you’re not in PECOS you might not get paid. CMS has plans to implement changes to Medicare’s Provider Enrollment, Chain and Ownership Systems (PECOS), which is used to enroll physicians into Medicare. Under the impending changes, CMS will deny claims for services ordered or referred by a physician who doesn’t have a PECOS file. That, of course, means no payment. CMS had set Jan. 3, 2011 for the implementation of the edits, but that has since changed. “CMS is working to resolve a backlog and other systems issues and promised to provide ample advance notice to the provider and beneficiary communities before CMS begins and such automatic denials,” Helen Olkaba, an economic analyst at the American College of Radiology, said in an e-mail. Olkaba said that CMS has not announced a date for when the edits will be turned on. CMS had originally planned to meet this requirement more than a year ago, but found that more than one-third of physicians who should be enrolled in PECOs had not done so, according to the ACR. So what should you be doing while CMS resolves the issues? First, if you’re not currently enrolled in PECOS, you should do so “sooner rather than later,” Olkaba said. Check out CMS’s site to verify whether you’re enrolled. And here are the instructions for enrolling in PECOS.