CMS informed the industry on March 4th that phase 2 of PECOS will go live on May 1, 2013. This means the provider will start receiving PR denials for those physicians that are not PECOS certified. If you receive the PR denial, you can no longer service this patient. At this point, you will need to contact the physician letting them know that you can longer service the patient until they are PECOS certified. You will also need to let the patient know so they can make a choice in switching to a PECOS certified physician.
Over 1400 claims were denied due to wrong NPI being used.
Here are some tips to avoid those PR denials on May 1st: (You need to be working on this now!)
- Create a list of those physicians that are not PECOS certified.
- 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.
- Check to make sure you are using the individual NPI not the physician group NPI.
- Do not use other group NPIs such as hospitals, clinics, etc.
- Do not use your own NPI for referring physicians.
- The denial is date of bill driven—hold your claim until physician is approved for PECOS, then bill original date of service.
- Not only will DMEPOS deny but any referral will deny including laboratory, x-ray’s, specialty services, etc.
- Teach physicians about the PECOS requirements.
Capped rentals are included in the ordering & referring edits and will be denied on or after May 1st if the physician is not PECOS certified. VA Military physicians are eligible to order and refer DMEPOS services. If they are not certified yet, they can use the internet-based PECOS or complete the CMS-8550 paper form. They will not be submitting claims to Medicare for services they furnish to Medicare patients. *The issue of VA physicians is being addressed with PECOS administration.
It’s imperative that you look at your PECOS listing and check for the individual NPIs. Also, look at your reports and check what you have listed for individual NPIs. Decrease your denials now before May 1, 2013!
Attached are sample letters to use for your physicians and for your patients.