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Medicare and PECOS

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csbilling:
Does anyone have any insight on the new mandates for entering "referring/ordering" physicians into Medicare PECOS? What about PA's, NP's? Has anyone ever used PECOS? Is it hard to enter them into it?

Any insight would be helpful!

Michele:
All providers are supposed to be in the PECOS system.  If they are not, and they refer patients or order services, then the claims for the services they refer/order are supposed to be denied because they are not in PECOS.  Any provider who is a Medicare provider must be enrolled.  If they have recently enrolled in Medicare or made any updates/changes to their Medicare enrollment then they should be in PECOS.   You can check to see if they are in PECOS on the following link:

http://www.cms.gov/MedicareProviderSupEnroll/downloads/OrderingReferringReport.pdf

If they are not in PECOS then they can either submit a paper CMS application to their Medicare carrier, or they can log in to the PECOS system and do the application on line.

Michele

csbilling:
Good to know, thanks!

Do you know if online application is extensive? Is it anything like CAQH? Or is it just a few questions then your done? I am wondering this because I may want to offer this service and charge my clients my time to do this for them.

Michele:
It is supposed to be the equivalent of the paper CMS, but personally I find the paper apps to be way easier.

Michele

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