Medicare Compliance & Reimbursement

Medicare carriers are just as eager as you are for your PECOS applications to be processed quickly.

One large Medicare payer aimed to clear up confusion about the internet-based provider, enrollment, chain and ownership system (PECOS).

During a June 24 "Ask the Contractor" call, payer officials from National Government Services (NGS), a Medicare carrier in 20 states, reminded practices that Medicare contractors maintain different CMS-855 enrollment forms depending upon your practice type, said Lindy Lady of NGS's provider outreach and education department, during the call.

For instance: The CMS-855I applies to individual physicians or nonphysician practitioners (NPPs), whereas CMS-855B is for group practices or other organization suppliers, other than durable medical equipment suppliers. "PECOS allows physicians and nonphysician practitioners or third-party staff on behalf of the physician or NPP to apply to enroll in the Medicare program or make changes to the enrollment information," Lady said. "Providers also may designate an authorized official who, once authenticated, can go and get others to be PECOS users."

What you cannot do with PECOS: Internet-based PECOS has many advantages, including making your enrollment process up to 50 percent faster, Lady noted. However, you cannot use PECOS to change the provider's name or social security number, or to change your existing business structure (for example, from a sole proprietorship to an LLC).

NGS will send your internet-based enrollment application back to you if their office does not receive your signed certification statement and any supporting documentation within seven days of receiving your  internet based enrollment application, Lady indicated.

Stamped signatures are not accepted on certification statements, and blue ink is recommended, Lady said during the call.

One caller questioned whether CMS might someday accept electronic signatures so the enrollment process won't be held up waiting for the certification statement.

However, CMS officials indicated that they hadn't heard of any plans to change the process.

But take heart: Your carrier shouldn't drag its feet for too long before it processes your application. CMS requires that Medicare contractors process 90 percent of the PECOS applications within 45 days of receiving the signed certification statement and supporting documentation, Lady noted.