PECOS —Get Ready for January 6th, 2014?

PECOS —Get Ready for January 6th, 2014?

How does it work?

  1. Go to oandp.com’s PECOS search tool
  2. Plug in the physician’s name and state. The tool will either confirm or “red flag” the entry

CMS informed the industry on November 6th that phase 2 of PECOS will go live on January 6, 2014.  This means the provider will start receiving CO denials for those physicians that are not PECOS certified.    If you receive the CO 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.

Here are some tips to avoid those CO denials on January 6tht: 

  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.

 

Capped rentals are included in the ordering & referring edits and will be denied on or after January 6th, 2014 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 January 6, 2014.

Attached are sample letters to use for your physicians and for your patients.  You can also reference the Med Learn Matters article number MLN SE1305.

For more information contact Peggy Walker at [email protected] or call 800-401-3643 or Ronda Buhrmester at [email protected] or call 888-665-6518.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/se1305.pdf