If you bill Medicare, regardless of whether it is for payment or denial, the physician who ordered the services must be enrolled in the PECOS database. For a little longer you will receive warnings on your Medicare EOB’s, but at some point (right now this looks to be January 2011), your claims will be denied.
The first step in addressing this regulation is to know where you stand. The Rock-Pond PECOS database audit solution will tell you exactly that, and more. For a one time fee of $600, Rock-Pond will batch audit your physician file as many times as you want for the next year. The alternative is hours of online lookup of physician data and manual tracking to continually check up on physicians that are not registered. The end result is still subject to human error.
The alternative is to spend a few minutes to initiate the PECOS Database Audit and know for sure.
- If you are using CPR+, HomecareNet or Ascend, we will automatically create a spreadsheet with your physician information including the NPI number, name, address and number of active patients to assess your risk. For all other systems, contact us and we’ll help you get the information out.
- Show you which patients are currently on service for each physician.
- Identify physicians who are enrolled but have a different first or last name than you have in your physician file (also a compliance requirement).
- Return you the audited file within 24 hours.
- Provide you with a list of invalid NPI numbers in your physician file.
- You can use the spreadsheet provided from the audit in a mail-merge process to send a letter to your physicians.
You will know how compliant you are and have a tool in place to monitor compliance. The end result is less risk, fewer claims denied and happier employees.
Order now – simply send an email to dataservices@rock-pond.comrequesting download instructions. Please include your Company name, Contact name, Contact phone, Contact email and we will get right back to you with download instructions.
Complete Installation and Processing Instructions
Or contact Matt at 858-935-1130 (matt@rock-pond.com)
BACKGROUND INFORMATION: Any physician who refers or orders services (DMEPOS, home health, specialist services [not defined by CMS], lab, or imaging) will need to be enrolled with Medicare in the Provider Enrollment, Chain and Ownership System (PECOS) by July 6, 2010. This includes any physician who has not submitted an updated enrollment application to Medicare since November 2003 or has had a change to their enrollment information during this time but has not reported the change. If physicians are not enrolled by July 6, the physician s who they refer patients to could see their claims reject. This enforcement goes beyond what is in the new health system reform law which says that by July 1, 2010, all physicians who refer/order home health and DMEPOS must be enrolled. The law does allow for the Secretary to require physicians who order/refer other services to be enrolled later, but CMS has decided to require them all to be enrolled in PECOS by July 6, 2010.
Earlier this year, the compliance date had been delayed to January 3, 2011. Physicians and other providers should not delay in verifying their current PECOS enrollment as the enrollment process takes about 45 days. To verify current PECOS enrollment, contact WPS Medicare enrollment at (866) 503-7664 or check the “Medicare Ordering and Referring File” periodically updated on the CMS Web site.
November 27, 2010, CMS delayed the compliance date, again. They gave no set date, only sometime in early 2011. If you have further information regarding this date please contact liz@rock-pond.com. She will be happy to accept any information you have to offer.
Find out what Rock-Pond Solutions can do for your organization. Click on the link below, or call 501-450-6446, and one of our representatives will follow up with you to schedule a demo of our reporting solutions.