Doctors who register with the Centers for Medicare and Medicare Services do so in this database (CMS). CMS created PECOS. All doctors who order or recommend patients for home healthcare services or supplies must be Medicare beneficiaries. PECOS ensures accurate data sharing and communication between providers and CMS. CMS started rejecting claims for Medicare home health services or supplies on January 6, 2014, from any doctors who are not PECOS-registered. CMS will progressively reject claims from providers who are not PECOS members. Physicians who treat Medicare patients should participate in PECOS or renew their participation to ensure that their patients can get the necessary supplies and treatment.
What exactly is PECOS In Medicare Provider Enrollment?
A provider may sign up for Medicare in the past using either mailed-in documentation or the PECOS or Provider Enrollment, Chain, and Ownership System, an online enrollment management system. Provider, Enrollment, Chain, and Ownership System is called PECOS. People and organizations can sign up as Medicare suppliers or providers using the online Medicare enrollment management system. You can also use this system to update your information, notify any changes to your enrollment record, renew your registration, exit from the Medicare program, and electronically sign and submit all your information Centers for Medicare & Medicaid Services oversee and maintain the PECOS system (CMS). The automatic processing of PECOS applications makes for a quick and secure procedure.
With PECOS, clinicians can modify Medicare registration in the following ways:
- Become a Medicare supplier or provider.
- Renew (revalidate) your registration
- Leaving the Medicare program
- Examine and update your data.
- Be sure to update your enrollment record.
- Sign documents electronically and submit them.
Physician Assistants, Certified Clinical Nurse Specialists, Nurse Practitioners, Clinical Psychologists, Certified Nurse-Midwives, and Clinical Social Workers must register with PECOS. If you are not enrolled in the PECOS system, all claims for goods or services you have prescribed will be rejected. This covers just Medicare claims. Your patients may need help to get the supplies they require if you are not in the PECOS system, which will delay or prohibit hospital discharges. Additionally, you could already have prescribed the products that are being rented. These things date back at least three years (oxygen, for example). Additionally, these claims will only be accepted if registered with PECOS.
Who Is Required To Register With PECOS?
To get payment, all medical professionals who treat Medicare enrollees must sign up with PECOS. These companies comprise:
- Physicians and Specialists
- Registered Nurses
- Physician Assistants
- Certified Clinical Nurse Specialists
- Nurse Practitioners
- Clinical Psychologists
- Certified Nurse-Midwives
- Clinical Social Workers
- Physicians/specialist employed by the Department of Veterans Affairs, the Public Health Service, or the Department of Defense/Tricare
What Happens If a Provider Fails to Register with PECOS?
Medicare claims and services will not be reimbursed if a provider is not registered in PECOS, and Medicare may stop covering prescription medications. The provider may order and refer patients, but they cannot bill Medicare for any treatments. Patient discharges might be delayed as a result, and they could not get the services or supplies they require for treatment. Providers should send complete enrollment applications with enough time for processing because third parties might need to verify them.
Process For Enrolling in PECOS
Once you've logged in to the PECOS system, you'll be taken through several steps to choose the proper application and submit your information. Choosing the right enrollment type within the PECOS system is crucial to transferring the correct data to Medicare for your enrollment record, just as choosing the correct paper application. A physician who signs up for Medicare for the first time on their own should anticipate spending an hour or more filling out the application and submitting all necessary supporting documentation. Once you've finished the application, you may eSign it and attach any papers needed for your enrollment record. You may finally submit your application online once you've finished all the data entering, electronically signed the application, and uploaded all required files. Your application is delivered to your state's Medicare Administrative Contractor (MAC) when filed through PECOS.
There is no specified turnaround time. However, most MACs finish the application in 60 days or less. You may check the progress of your application online directly with the MAC on their website or via the PECOS application status check page after submitting it through PECOS.
The Advantages of PECOS for Healthcare Suppliers and Providers
The introduction of PECOS has several advantages for all parties associated with the Medicare program. The first of these is:
- Initial enrollment is up to 25% quicker than with the paper approach currently in use (45 days for online processing vs. 60 days for paper)
- The application procedure does not employ a "shotgun" strategy and merely requests pertinent data.
- Providers and suppliers have 24/7 access to the data in their files, making it easier for them to update important information on time.
- Reduced time spent on bureaucratic and administrative tasks to sign up for, change, or end the partnership
- PECOS establishes a consolidated repository for information on Medicare suppliers and providers, centralizing the provider enrollment process. This national database, notwithstanding its flaws, aids in the government's detection of fraud and misuse.
- Alternative to the paper application process: PECOS provides providers and suppliers with an online option to apply to participate in Medicare and to update their information as necessary. Paper enrollment forms are still accessible.
Potential Problems When Using PECOS
Even though CMS highly recommends PECOS, some people need help utilizing the program. The 15-day window for the carrier to acquire the signature sheets might need fixing if you enroll your providers through a Payor Enrollment organization or outside vendor. The signature pages can only be printed once the online application has been submitted. The local office personnel frequently need to appreciate the importance of receiving things back on time. These pages cannot be sent through fax or email because CMS still needs a "wet" signature. You must restart the enrolling procedure if you miss your deadline. What should ultimately save you time may cost you. Getting the provider's UserID and Password to access their PECOS file presents another difficulty. Most of the time, the supplier still needs to update this information. Anyone may find it challenging to gain this, but outside enrollment staff may find it particularly difficult. NPPES will only divulge this information to the provider in question. Even if all it takes is a phone call, a busy practice may continually put off making the call throughout the day.
Healthcare organizations should take many procedures to verify provider information to get comprehensive, reliable data. For example, healthcare providers must check provider credentials to ensure correct PECOS enrolment.
- Use a variety of data sources. Unfortunately, each collection of healthcare data is limited. Therefore, it is necessary to thoroughly verify several state and federal databases, including sanction and debarment lists, state licensing boards, and others.
- Cross-referenced IDs should be verified. Unique IDs that are standardized do not exist. The key is correctly determining and confirming a provider's identification.
- Recognize that the categories and criteria used by each data source vary.
The PECOS System's cost
The PECOS system has no associated consumer charges. However, when institutional providers and suppliers enlist, re-enroll, revalidate, or add a new practice site, they must pay an application fee. These providers offer Medicare diabetes preventative programs, opioid treatment programs, prosthetics, orthotics, and durable medical equipment. In 2022, the application price will be $631. There is no application cost for doctors, other healthcare professionals, or provider groups.
Using PECOS To Look For A Provider
A database of providers who have registered with CMS may be found in the PECOS system. A National Provider Identifier (NPI) is required to register with PECOS. To find the provider in the database, use that identification. You can look for a provider's details in the NPI registry even if you don't know their NPI number. To quickly check a provider's NPI and learn more about the provider, use our free NPI Lookup tool.
Change in PECOS Status
The Affordable Care Act mandates that suppliers and providers revalidate their enrollment data following updated screening standards. Additionally, the CMS Medicare Administrative Contractors will contact providers to update their enrollment application every three to five years. The Medicare Revalidation Lookup Tool will look up providers' statuses to determine their enrollment. The provider is active and does not need to renew enrollment if the tool indicates "TBD." If one is specified, the renewal must be sent within six months after the provider's due date. It is essential to check this database periodically.
The Provider Enrollment, Chain, and Ownership System (PECOS), a web-based tool, is used to establish communication between healthcare providers, suppliers, and the federal organizations managing the Medicare program. Nearly 50 million Americans, primarily the elderly, have access to medical coverage through Medicare. As a result, it sends and receives enormous amounts of data daily. PECOS is crucial in enabling and overseeing enrollment since it ensures that providers and suppliers are appropriately tracked via the Medicare system.