PECOS Dear Physician Letter
Dear Physician:
CMS is expanding claim edits for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics and Supplies.
Effective, April 5, 2010, Durable Medical Equipment, Orthotics, Prosthetics and Supplies (DMEPOS) suppliers will not receive payment from Medicare for items that you ordered if you do not have a current enrollment in the Medicare Provider Enrollment, Chain and Ownership System (PECOS). This could result in your patient not receiving the item or being held financially liable. Help your DMEPOS supplier continue to provide quality service to your patients by promptly enrolling in PECOS, or update your Medicare enrollment if you haven’t done so recently.
For any DMEPOS item to be covered by Medicare, it must be ordered by a physician or a practitioner who is eligible to order such items. Physicians or practitioners must be enrolled in PECOS and must be indicated in the system as specialty eligible to order DMEPOS items for Medicare beneficiaries.
The providers who can order DMEPOS items include –
Doctor of:
Medicine or Osteopathy
Dental Medicine or Dental Surgery
Podiatric Medicine
Physician Assistant
Certified Clinical Nurse Specialist
Nurse Practitioner
Optometry
In order to continue to order DMEPOS for Medicare beneficiaries, you will have to enroll in the Medicare program or “revalidate” your Medicare enrollment information. You may do so by:
Using Internet-based PECOS (be sure to mail the signed and dated Certification Statement to the carrier or A/B MAC immediately after submitting the application), or
By filling out the appropriate Medicare provider enrollment application(s) and mailing it, along with any required information, to the local Medicare carrier or A/B MAC, who will enter your information into PECOS and process your enrollment application.
To confirm if you have a current enrollment record in Medicare, contact your designated enrollment contractor or you can go on-line, using Internet-based PECOS, to view your enrollment record. While doing so, if you have a PECOS record, ensure that your NPI is in it. If it is not, update your enrollment record.
For additional information regarding PECOS refer to: http://www.cms.hhs.gov/MedicareProviderSupEnroll
Sincerely,
Paul J. Hughes, M.D.
Medical Director
NHIC
DME MAC, Jurisdiction A