PECOS

Doctors who receive payments for treating Medicare beneficiaries are enrolled in Medicare (regardless of whether they are participating or non-par).

PECOS is a database of doctors who have enrolled or re-enrolled in Medicare since November 2003.
Medicare has established policies that effectively require doctors to have their Medicare enrollment record in the PECOS database.

If the doctor's enrollment record is not in the PECOS database (that is, if she/he started seeing Medicare patients before 2003), then she/he must re-enroll in Medicare to create an enrollment record in the PECOS database.

There are 2 ways to enroll/re-enroll in Medicare: On paper (CMS-855 forms) or online (using what's called Internet-based PECOS).

  • Re-enrolling on paper takes about 60 days. Re-enrolling online takes about 45 days.
  • AOA strongly encourages doctors to review CMS guidance and tips prior to submitting an enrollment application.
  • AOA strongly encourages doctors to contact their local Medicare Part B contractor/carrier if they have any questions about enrollment prior to submitting an enrollment application.
  • AOA recommends re-enrolling online because it's faster and, like using tax preparation software, helps correct errors in advance.

Note that you might not receive any Medicare payments until the application is approved!

In January 2011, doctors who do not have their NPI in their Medicare enrollment record will not be paid.
Doctors who are in PECOS can update their enrollment record to add the NPI.
Doctors who are not in PECOS must re-enroll in Medicare to add the NPI to their enrollment record.
Thus, all doctors who have an NPI in their enrollment records should also be in the PECOS enrollment database.

Since July 2010, CMS has required all Medicare orders and referrals to be made by doctors who have a complete enrollment record in PECOS. However, CMS has not started to reject or deny claims that do not comply.

AOA believes that CMS will begin rejecting noncompliant claims in January.
A small number of doctors who do not receive payments for treating Medicare beneficiaries might still need to submit a simplified Medicare enrollment application to make sure their orders/referrals are covered.

For the Medicare EHR incentives beginning in 2011, CMS requires the doctor to have a complete enrollment record in PECOS to receive any bonus payment.

Thus, it's imperative that optometrists who treat Medicare patients have a complete (with NPI) enrollment record in PECOS.

To learn more about Medicare enrollment, start here:
http://www.cms.gov/MedicareProviderSupEnroll/

PECOS BASICS

The Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) was developed for use in lieu of the Medicare enrollment application (i.e., paper CMS-855), according to the U.S. Centers for Medicare & Medicaid Services (CMS). It can be used to:

  • Submit an initial Medicare enrollment application.
  • View or change your enrollment information.
  • Track your enrollment application through the web submission process.
  • Add or change a reassignment of benefits.
  • Submit changes to existing Medicare enrollment information.
  • Reactivate an existing enrollment record.
  • Withdraw from the Medicare Program.

Advantages of Internet-based PECOS, according to the CMS, include:

  • Faster-than-paper-based enrollment (45 day processing time in most cases, vs. 60 days for paper).
  • A tailored application process – meaning practitioners need only supply information relevant to their application.
  • More control over practitioner enrollment information, including reassignments.
  • Easy checking and updating of information for accuracy.
  • Less staff time and administrative costs to complete and submit enrollment to Medicare.

Health care practitioners can learn how to use the system by visiting the CMS’ online Medicare Physician and Non-Physician Practitioner Getting Started Guide. (www.cms.gov/MedicareProviderSupEnroll/downloads/GettingStarted.pdf)
The CMS has established an External User Services (EUS) Help Desk as well as other resources to assist physicians and non-physician practitioners who encounter application navigation or access problems with Internet-based PECOS. To report an application navigation problem (i.e., the practitioner is unable to determine how to use Internet-based PECOS) or access problem (i.e., the system is not operational, operating slowly, or a system-generated error message prevents data entry) with Internet-based PECOS, contact the EUS Help Desk at 1-866-484-8049 or send an e-mail to the EUS Help Desk to EUSSupport@cgi.com.

  • For help in establishing a National Plan and Provider Enumeration System (NPPES) User ID and password – required for PECOS access – or assistance in changing an NPPES password, contact the National Provider Identifier (NPI) Enumerator at (800) 465-3203 or send an e-mail to customerservice@npienumerator.com
  • If a physician or non-physician practitioner has a valid NPPES User ID and password, but is able to access Internet-based PECOS, contact the EUS Help Desk at (866) 484-8049 or send an e-mail to the EUS Help Desk to EUSSupport@cgi.com.
  • Health care practitioners with provider enrollment questions should contact their state Medicare contractor. Medicare provider enrollment contact information for each state can be found in the download section of www.cms.hhs.gov/MedicareProviderSupEnroll.