Pitfalls after Enrolling In PECOS and Medicare I & A

Posted by KUNAL JAIN on Aug 4 2015

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Consider this: You have enrolled correctly but still your payment from Medicare got stuck. What happened? Well, you might have missed out updating an important record or delayed your Revalidation request. Read below on these and Expert Practical Tips from CEO, Practice Forces to know the finer points.

And, in case you still have not enrolled, here is a complete guide to enrolling in PECOS I & A, written in my earlier post. 

Updating PECOS Record:

Any change that affects information in a Medicare enrollment record must be updated.

  1. Effective January 1, 2009, physicians and non-physician practitioners are required to report important changes within 30 days like change in ownership, change in practice location. For full details on other reportable events, refer here.
  2. Physicians and non-physician practitioners are required to report the following changes immediately, but not later than 90 days, after the reportable event:
  • Change in practice status (e.g., retirement, voluntary surrender of medical license or voluntary withdrawal from the Medicare program)
  • Change of business structure, Legal Business Name or Taxpayer Identification Number
  • Banking or payment information
  • Change in the correspondence or special payments address

Revalidation of Information:

Providers and suppliers, including physicians, are required to revalidate their information every five years on the anniversary of their approved PECOS enrollment date, while certain suppliers, including physicians who furnish durable medical equipment (DME), are required to revalidate their information every three years.  Medicare Contractors will notify providers/suppliers at least 60-days prior to their revalidation date. 

Who Do I call If I Get Stuck?

If you come across a situation that you cannot solve by yourself, refer to the matrix that will help you identify which CMS organization to contact. Included at the bottom of this document is a contact list for each CMS organization noted within the matrix. 

EXPERT TIPS:

At Practice Forces, we have gathered these tips through practical experience. We see so many practical issues that a physician or, practice faces and they come to us for help. Just wanted to highlight these – it might be useful for some of you out there.

  1. Keep your PECOS I & A User login & password private. Do not share with anyone. This user id can be used to access all your records across these systems NPPES NPI, I&A, PECOS, EHR Incentive & MEDICARE programs. 
  2. Make sure you give your personal email & mobile number or the one you can access easily. If you need to change password and use ‘Forgot Password setting’, this will come in handy.

           Note: CMS recommends that PECOS users change their PECOS passwords at least once a year. User IDs cannot be changed.

  1. If your correspondence address changes, make sure update that immediately. Sometime practitioners take a back seat on this thinking that the payment is transferred electronically, so it is okay to buy some time. BUT, if Medicare sends correspondence, and their mail gets returned because your address has changed - your payments will get stopped!
  2. Medicare does not have address forwarding for their mails so, DO NOT NEGLECT address update. This small error on your part might prove to be very costly!
  3. Take revalidation requests on priority. Generally, you will be given plenty of time, around 3 months for revalidation. However, if you do not respond within this period, your Medicare account can get cancelled or, suspended.
  4. Medicare Number revocation, suspension or, cancellation will lead to financial loss for your practice. If you do not apply for a new Medicare number within a month’s time, you might lose reimbursement on claims for that period.

You can rely on us for completing your revalidation request at a reasonable fee for $1250.

 

Simply call us at 866-634-6327 or drop us a quick note at sales@practiceforces.com

Sources & Resources:

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/InternetbasedPECOS.html

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/CMSProviderEnrollmentAssistanceGuide.pdf

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/downloads/internet-basedPECOSFAQ.pdf 

Topics: Enrollment, Medicare, PECOS, Revalidation, NPI

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