Links and Industry Updates

Power Mobility Checklist

Are you a customer with questions about how to get your power wheelchair or scooter paid for by Medicare? Or, are you a physician, homecare agency or therapist that would like more details of what Medicare is looking for regarding documentation for your patient's power mobility? If so, then click on the link for a simple checklist and detailed information about Medicare's rules for power mobility payment.

Download the Power Mobility Coverage Checklist

PECOS Update

The Centers for Medicare & Medicaid Services (CMS) will delay until January 3, 2011, the implementation of Phase 2 of Change Request (CR) 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)) and CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)).

This delay will give physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers sufficient time to enroll in Medicare or take the action necessary to establish a current enrollment record in Medicare prior to Phase 2 implementation.

Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and contains the NPI. Under Phase 2 of the above referenced CRs, a physician or non-physician practitioner who orders or refers and who does not have a current enrollment record that contains the NPI will cause the claim submitted by the Part B provider/supplier who furnished the ordered or referred item or service to be rejected.

CMS continues to urge physicians and non-physician practitioners who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003 to update their enrollment record now. If these physicians and non-physician practitioners have no changes to their enrollment data, they need to submit an initial enrollment application which will establish a current enrollment record in PECOS.

What is PECOS?

The Provider Enrollment, Chain and Ownership System (PECOS) is an online system that allows you to manage your physicians or other healthcare practitioners, provider file at Medicare. Medicare requires that you register with their PECOS system by January 4, 2010 to prevent claim denials for items that you prescribe.

If you are not enrolled in internet PECOS claims for items that you prescribe or previously prescribed (if being rented) Medicare will begin to reject as of April 5, 2010.

What does the acronym PECOS mean?

The Provider Enrollment, Chain and Ownership System. Registration is at:
https://pecos.cms.hhs.gov/pecos/login.do

I'm already enrolled in Medicare, do I need to enroll with PECOS also?

YES! You must enroll with PECOS before April 5, 2010. If you have enrolled with the program since 2003 you may already be in the system. HOWEVER, it is very important to your patients that you verify your PECOS status. Otherwise they may not receive the items you prescribe.

I'm enrolled as part of a group with Medicare. Am I in PECOS?

NO! You need to enroll immediately.

Why haven't I heard of it before?

Medicare has encouraged physicians to update their provider files since 2006. However, it has never impacted the payment of claims for referred items or services. Beginning in October of 2009 the first phase of the system was implemented.

Under the first phase claims are being paid but with a warning that the provider is not in the PECOS system.

The second phase begins on January 4, 2010. At that time claims for items referred by physicians who are not in the system will deny.

What other professionals must register with PECOS?

Non-physician practitioners who are eligible and those are:

    • Physician Assistants
    • Certified Clinical Nurse Specialists
    • Nurse Practitioners
    • Clinical Psychologists
    • Clinical Social Workers

I have an NPI number, am I in PECOS?

Probably not. Your National Provider Identification (NPI) is not registered with the PECOS system until you complete the registration process.

What happens if I do not register?

Beginning April 5, 2010 any claims for items for services that you have prescribed will be denied if you are not in the PECOS system. This applies to Medicare claims only. Not being in the PECOS system will make it difficult for your patients to receive the items they need and will prevent/delay hospital discharges.

Also, you may have previously prescribed items that are being rented. These items can go back three years or more (oxygen for example). These claims will also deny if you are not registered with PECOS

How to register with PECOS:

    1. Have an NPPES User ID and password to use Internet-based PECOS.
    2. Go to Internet-based PECOS at: https://pecos.cms.hhs.gov and complete the electronic enrollment.
    3. Print, sign and date and mail the 2-page Certification Statement as instructed.

Need more info?
www.getpecos.com

PECOS LINKS:

Pecos Web Site

Contact Information

Getting Started

Organization and Getting Started

Organization Overview

PECOS Web Screen Example

COMPETITIVE BIDDING

Competitive Bidding is something many in our industry have known about for several years now. Integrated Medical is committed to continuing to service our referral sources and patients through our one call model. Round 1 will commence on January 1, 2011 and Integrated will still be here to serve the same Ohio communities that we have in the past. We will continue to walk with you and educate you throughout the medical equipment process. Below is a link with further information directly from the Centers for Medicare and Medicaid with further up to date information.
http://www.dmecompetitivebid.com/Palmetto/Cbic.nsf/DocsCat/Home