CMS informed the industry that Phase 2 of the Internet- Based Provider Enrollment, Chain, and Ownership System (PECOS) will be implemented May 1, 2013. For those providers that order or refer items or services for Medicare beneficiaries and are not yet enrolled by this date will start to receive denials. The PECOS implementation effects durable medical equipment, Part A, Part B, and home health agencies.
To see if a provider is enrolled in the PECOS system, the tool is available on www.vgm.com under Everything VGM titled PECOS Lookup Tool.
Be sure to get the individual NPI from the referring provider and not the group NPI.
If the physician is not PECOS certified, then the supplier will receive a PR denial which means it’s patient responsibility. By getting the patients involved, the physician may be more apt to become enrolled in PECOS.
To read more information on the PECOS article, refer to the MLN Matters # SE1305.