CMS Delays PECOS Implementation


PECOS edits were set to go live on May 1, 2013, however dueto technical issues it has been delayed.This is good news for the suppliers because you now have more time toget those referring physicians that are not enrolled in PECOS, enrolled andeducated on the PECOS policy.   .    

Do not stop preparing and pay attention to thosealerts.  The helpful tips listed beloware still important to follow until the new deadline is set.     

Helpful tips for PECOS alerts/denials:  (Youneed to be working on this now!)

  1. Create a list of those physicians that are not PECOS certified.
  2. Contact the physician letting them know they are not PECOS certified which means you can no longer service their patients and cannot take future referrals they are registered in PECOS.
  3. Check to make sure you are using the individual NPI not the physician group NPI.
  4. Do not use other group NPIs such as hospitals, clinics, etc.
  5. Do not use your own NPI for referring physicians.
  6. The denial is date of bill driven—hold your claim until physician is approved for PECOS, then bill original date of service.
  7. Not only will DMEPOS deny but any referral will deny including laboratory, x-ray’s, specialty services, etc.
  8. Teach physicians about the PECOS requirements.


Remember:  Capped rentals are included in the ordering & referring edits andwill be denied on or after May 1st if the physician is not PECOScertified.    VA Militaryphysicians are eligible to order and refer DMEPOS services.  If they are not certified yet, they can usethe internet-based PECOS or complete the CMS-8550 paper form.  They will not be submitting claims toMedicare for services they furnish to Medicare patients.  *The issue of VA physicians is beingaddressed with PECOS administration.

For more information contact Peggy Walker at or call800-401-3643 or Ronda Buhrmester at ronda.buhrmester@vgm.comor call 888-665-6518.