CMS Releases Final Rule Outlining Changes in Provider Enrollment Requirements for Ordering Referring Physicians
On April 27th, the Centers for Medicare and Medicaid Services (CMS) issued a final rule outlining changes in provider enrollment for ordering and referring physicians in Medicare. The rule clarifies that these requirements will only apply to those who order or certify: durable medical equipment, prosthetics, orthotics, and supplies (DEMPOS); clinical laboratory services; imaging; and home health services.
On December 15 2008, the Centers for Medicare and Medicaid Services introduced PECOS, which will allow physicians and non-physician practitioners to enroll, make changes in their Medicare enrollment, view their Medicare enrollment information, and check the status of their Medicare enrollment applications via the Internet. CMS has since expanded the program to all states. Currently, PECOS is only available to physicians and NPPs, and CMS plans to adopt PECOS for organizations in early 2009, and implement PECOS for Durable Medical Equipment, Prosthetics, Orthotics, and Suppliers (DMEPOS) in 2010. By initiating PECOS, CMS hopes to reduce the administrative burden on practices associated with completing and submitting enrollment information to Medicare, allow physicians and NPPs to conveniently review and validate their Medicare enrollment information, streamline the Medicare enrollment process, and reduce the time spent to complete the enrollment form.
In order to use PECOS for enrollment you should ensure that you have an active National Provider Identifier (NPI) and National Plan and Provider Enumeration System (NPPES) User ID and password (PECOS is accessible using your NPPES user ID and password).
CMS has proposed that you adopt the following steps to protect your Medicare enrollment information:
- Change your NPPES password before accessing Internet-based PECOS for the first time and that you change your password periodically at least once a year.
- Ensure that you periodically check your enrollment data in PECOS for accuracy and make sure that no one has tampered with your records. If you notice any invalid changes, you will need to report these to your Medicare contractor
Securely store printed copies of your Medicare enrollment information, or paper CMS-855 and CMS-588 forms
- Ensure your Medicare payments are electronic and go directly into your bank account. Medicare requires newly enrolling providers and suppliers to complete form CMS-588, Electronic Funds Transfer Authorization Agreement, which will enable Medicare to send payments directly to a provider/suppliers bank account.
CMS has assembled the External User Services (EUS) Help Desk to assist enrollees with any application navigation or access problems they may experience with PECOS. CMS defines an access problem if PECOS is operating slowly or a system generated error message prevents data entry. After submitting your application electronically, CMS requires that Medicare contractors process 90 percent of the application within 45 days compared to CMSs requirement for the Medicare contractors to process 80% of the paper applications within 60 days. Once you submit your application, there are four statuses that it can have:
Submitted- This occurs after you submit your application, with this status you might still need to send additional supporting information to the Medicare contractor to ensure complete processing of your application.
In-Process- This signifies that the Medicare contractor is reviewing your enrollment application.
Returned for Corrections- This occurs when the Medicare contractor returns the application to you for correction. You should respond to this request within 30 days of receipt from the contractor to prevent processing delays or rejections from the contractor.
Approved/Denied- This occurs after the Medicare contractor has processed your enrollment application.
To enroll in Medicare via PECOS, visit this link.
Internet based PECOS. Accessed at http://www.cms.hhs.gov/MedicareProviderSupEnroll/02_Internet-basedPECOS.asp on December 17, 2008
Updated June 2010