If you take Medicare, you already know (or should know) about PECOS.
PECOS is the Medicare “Provider Enrollment, Chain, and Ownership System.” Medicare is requiring all doctors to be enrolled in the PECOS system.
How do you do this?
Simply by making any kind of change to your Medicare status – such as, an address change, or enrolling in electronic payment. Medicare requires that with any kind of change to your Medicare status, you also enroll in the PECOS system.
OK, so now that you have already enrolled into PECOS, everything is OK, right? Well, not exactly.
If you dispense items (such as Durable Medical Equipment (DME) or any other item that requires referring authorization), the authorizing physician also needs to be enrolled in PECOS or your claim will be denied.
For example, a podiatrist believes the patient requires diabetic shoes. He gets authorization from the doctor who monitors the patient’s diabetes and subsequently dispenses the shoes prior to billing Medicare – only to find out, later on, the payment was denied. Why? Because the authorizing doctor is not enrolled in PECOS.
The podiatrist is in the PECOS system and does everything by the book, and still the claim is denied.
This is what will happen beginning January 1, 2011 (as of right now, Medicare is just issuing warnings).
What a pain. It’s up to the rendering provider (the podiatrist, in this case) to make sure the referring provider (the PCP) is enrolled in the PECOS system. And how is that done? Well, you have to go online and search for the PCP in the PECOS database – and lately, who has time for that?
Well, KIP has changed all that.
Beginning with KIP Deluxe version 11.2, if you see a green check mark next to the referring provider’s name, everything is A-OK.
See a red “X” and, instantly, you know this doctor is not PECOS enrolled.
That’s it. Nothing else to do.
Do you see a green check mark? Then, everything is OK.
See a red “X – oops, not in PECOS.
No searching. No going online. Nothing to click. Nothing to do at all. Once the PECOS update is installed into KIP, it’s all 100% automatic.
Now, you can be reassured that your claim will go through, and eliminate denials because the referring doctor is not enrolled in the PECOS system.