Author Topic: Medicare question...  (Read 1807 times)

kwardbilling

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Medicare question...
« on: July 22, 2010, 08:34:32 AM »
Hi Michelle, I am wondering, I have a provider who had been approved with medicare, got a ptan number, but hasn't used it for a long time.  She called them and she has to submit a new application.  Does this mean she starts at the total beginning of the application process, or will her application move more quickly since she already had a ptan number? If you had to give an estimate, how long do you think it will take before she can submit claims, maybe a month or so?  Or longer?

Thanks for any info.
Karen

blhoffman

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Re: Medicare question...
« Reply #1 on: July 22, 2010, 12:06:57 PM »
Hi kwardbilling,

What happened is, the federal government wanted all providers to update their application information in PECOS and the deadline was Jan. 2010, but there was an uproar that it was too soon. So they pushed it back until July 1, 2010. If you update the information in PECOS you should be okay. I would give it a try before doing the entire application process again.

I spoke with our new  ;D consulting company rep. in the office (they are heavily involved with Medicare billing for other companies) and she said they are still taking the updates on PECOS even though it is after the deadline. If you don't get it done then you definitely will have to do the application process over.

P.S. If you do update and get squared away. If for any reason you have a patient referred to you and that referring physician doesn't update in PECOS, they YOUR claim will still be denied. Yup, you will get denied if the referring physician does not update. Just an FYI to everyone.

Hope that helps.


Brenda

blhoffman

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Re: Medicare question...
« Reply #2 on: July 22, 2010, 12:07:41 PM »
Shoot - forgot to add the link!  :-[

http://www.cms.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp

This should help you out.

kwardbilling

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Re: Medicare question...
« Reply #3 on: July 22, 2010, 12:10:34 PM »
Hi thanks for the response....I am wondering though, if it is because of PECOS......she hadn't done any billing under her medicare number in over a year.....I think it expired.?  She was told she had to do a complete new application......thoughts?

Michele

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Re: Medicare question...
« Reply #4 on: July 24, 2010, 08:14:27 AM »
If a provider has not filed a claim (successfully) in a one year period their PTAN is deactivated.  That is a little different than the PECOS update, but that information is correct too.  They are trying, albeit not very successfully to get all providers into the PECOS system.  We have an article in our newsletter that was just released about it.

Anyway, your provider must submit an app to reactive their PTAN.  It might not take as long, but will still be probably 6-10 weeks, depending on your state.  Right now they are receiving more apps than normal because of the PECOS thing.  if a provider doesn't want to or doesn't have the capability of doing PECOS they can send in a paper app.

Also, the PECOS deadline was still July 6th, but they didn't implement the rules to stop payments if PECOS isn't done, so they still weren't successful!  Personally I don't like the rule since the provider that isn't in PECOS is not the one who is penalized.

Michele
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kwardbilling

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Re: Medicare question...
« Reply #5 on: July 24, 2010, 02:43:47 PM »
thanks, that's what I thought, I thought it would take a couple of months, but she seems to think within 15 days....I'll have to give her a heads up.  I'll also have to look into the pecos thing a little more, don't feel like I have a good handle on that.  thanks for the info.

karen

blhoffman

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Re: Medicare question...
« Reply #6 on: July 29, 2010, 09:56:05 AM »
Quote
Also, the PECOS deadline was still July 6th, but they didn't implement the rules to stop payments if PECOS isn't done, so they still weren't successful!  Personally I don't like the rule since the provider that isn't in PECOS is not the one who is penalized.

We had three claims deny last week. When we called, we were told the reason was due to PECOS not being updated. I've also heard from a friend in their office, they too have had rejections based on this reason. Its very frustrating to say the least.