PECOS registration? -requirement for MD/ DO/NP/PA ordering Medicare paid services

[SteveDE]

Ok, we have a patient we re-started on an insulin pump, this patient has medicare as primary, to get her approved for more than 3 test strips per day, medicare is saying the provider must register on pecos.cms.hhs.gov. This is something we haven't done previously, however, we haven't done much with insulin pumps through our clinic in the past either.

The pharmacist even reported, they hadn't heard of it, yet medicare was telling them for approval the prescriber would have to register. Any advice would be greatly appreciated, any experience with this?

Thanks!

[NRSKarenRN, BSN, RN]

The ACA /Obamacare legislation requires that all MEDICARE enrolled physicians are now required to re-enroll in Medicare every 5 years, now using the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) website. This re-registration checks that physician has active medical license, has not committed fraud against government programs,not been disbarred by OIG, no federal liens, no fraud/abuse legal convictions, etc. Additionally, physicians enrolled in state MEDICAID programs, also need to re-enroll in their state program too. This is all part of protecting Medicare from Fraud and Abuse, saving program $$$.

Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that were enrolled prior to March 25, 2011. Newly enrolled providers and suppliers that submitted their enrollment applications to CMS on or after March 25, 2011, are not impacted. Between now and March 23, 2015, MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier.

Website: Welcome to the Medicare Provider Enrollment, Chain, and Ownership System

Effective 1 1 2014, Home Health agencies, Durable Medical Providers (DME), orthotic and pharmacies are unable to get paid for services if prescribing physician not enrolled in Medicare. http://cgsmedicare.com/jc/forms/pdf/dear_physician_pecos.pdf

Please ask your BILLING COMPANY for assistance/ more information if needed.

Over the past 3 years, I had to track 10,000 physicians enrollment in employers home care EMR, down to just 400 not enrolled. PM me if more info needed.

[NRSKarenRN, BSN, RN]

PS this also applies to Nurse Practitioners, CNS and Physician Assistants too.

The Basics of Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for Physicians and Non-Physician Practitioners,” Fact Sheet, ICN 903764, Downloadable only.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MedEnroll_PECOS_PhysNonPhys_FactSheet_ICN903764.pdf