November 2010 Newsletter
Update: PECOS has been delayed. See this bulletin for more information.
Enforcement of PECOS Enrollment
On January 3, 2011, CMS plans to activate the new ordering/referring provider edits for Medicare Part B claims. The impact of these edits is that claims will be rejected if ordering/referring physicians have not enrolled in PECOS (Provider Enrollment, Chain, and Ownership System) or cannot be matched to a name in the system.
Actually, the deadline for enrollment in PECOS was July 6, 2010, but enforcement was delayed. During the delay, CMS is returning informational messages (Remark Codes N264 and N265) on remittances for claims with non-enrolled physicians, noting that PECOS issues need to be resolved. The Xpeditor "PECOS Warning Report" can identify claims with these Remark Codes to alert Xpeditor clients about providers who are not properly registered in PECOS. HARP clients can request similar statistics to help them identify providers with PECOS issues based on these Remark Codes. Contact your account representative if you need their assistance.
Another method for verifying if physicians are registered is to check the Ordering/Referring Report from CMS, which lists all enrolled providers. While the report is helpful for verifying the PECOS status of physicians, it does not necessarily contain the latest data. According to the CMS site, “A new file will be made available periodically,” but it does not indicate how often. Quadax account representatives have access to the report and other tools for assisting clients in determining if providers are enrolled in PECOS, and they are ready to help as needed.
Be sure to identify your ordering/referring physicians or non-physician practitioners who are not registered in PECOS and encourage them to enroll as soon as possible. It can take up to 60 days for processing enrollment applications. Providers can submit PECOS enrollment applications online. Alternately, they can fill out and return the appropriate application forms, available from CMS. Processing is faster for online applications. Registered providers can update their information through Internet-based PECOS.
Payments will not be made for claims received on or after January 3, 2011 if the ordering/referring physician is not enrolled in PECOS so act now to avoid costly rejections!
Tips for avoiding claim rejections for PECOS issues:
In the ordering/referring physicians’ names on claims:
- Use all uppercase letters for electronic claims.
- Do not use commas, periods, or apostrophes.
- Do not use nicknames, such as Bob instead of Robert.
- Do not use credentials, such as Dr. or MD.