Impacted Physicians Should Initiate PECOS Enrollment ASAP
In order to ensure adequate time to process applications before the January 3, 2011, enforcement deadline, Medicare is strongly encouraging physicians who are not currently enrolled in the PECOS system - a national database in which all Medicare provider data is stored - to initiate Medicare enrollment as soon as possible.  Effective January 3, 2011, physicians will no longer be paid for Medicare services if the ordering or referring physician is not enrolled in the PECOS system.  Physicians who are not enrolled in PECOS will be required to complete a Medicare enrollment application either online or by using the CMS 855 paper applications.  Applications are generally processed within 60 days, but can take longer if the application is incomplete or additional information is needed.  Therefore, impacted physicians are encouraged to begin the process soon.

Medicare has started sending billing providers remittance notices on EOBs when claims fail the "ordering/referring provider edits".  Palmetto, California's Medicare carrier, has also started contacting impacted physicians and notifying them of the need to enroll.  Affected claims will, however, continue to be paid through January 3rd.

Physicians who need to confirm whether they are enrolled in PECOS may do so by contacting the ACCMA at 510-654-5383.  In the event that you are not currently enrolled in the PECOS system and need to initiate a new enrollment, the ACCMA and CMA can provide you resources and assistance.

To reduce the likelihood of Medicare payment interruptions, the ACCMA strongly recommends that members take the following immediate steps:

1. Verify whether you are enrolled in the PECOS system. The ACCMA can look this up for you if you call the ACCMA at 510-654-5383.  If you are enrolled, no additional further action on your part is necessary.

2. If you are not enrolled in the PECOS system, begin completing the online or paper-based enrollment process as soon as possible.  CMA has developed a step-by-step PECOS Enrollment Guide to walk physicians through the process, from determining if you are already in PECOS to accessing the Internet-based PECOS enrollment system.  You may also call the ACCMA at 510-654-5383 for a copy.

3. Contact the ACCMA for assistance with the PECOS enrollment process.  If you need additional assistance completing the Medicare enrollment process, contact the ACCMA at 510-654-5383.

Physicians should also be aware that federal law requires physicians who are enrolling or revalidating their PECOS enrollment to also sign up for electronic funds transfer (EFT). Although the online PECOS revalidation process appears to allow you to opt-out of EFT, opting out is not an option. If you do not also complete the CMS-588 form to enroll in EFT, your claims will not be paid.

For more information or assistance, contact the ACCMA at 510-654-5383.