Whether you’re enrolling your provider with Medicare for the first time or responding to a revalidation request, knowing how to correctly utilize CMS’ Provider Enrollment, Chain, and Ownership System or PECOS Medicare enrollment system is essential.
What is the PECOS Medicare Enrollment system, anyway?
PECOS is an internet-based enrollment process that provides you with an easy way to submit, update and view your providers’ Medicare enrollment information. To use the PECOS Medicare enrollment system your provider must be an eligible Medicare provider or supplier.
With PECOS you can:
- Submit a Medicare enrollment application
- View, change or track your enrollment information
- Add or change a reassignment of benefits
- Submit changes to existing Medicare enrollment information
- Reactivate an existing enrollment record
- Withdraw from the Medicare Program
- Submit a Change of Ownership (CHOW) of the Medicare-enrolled provider
There are a variety of documents that you will need to have on hand before your PECOS Medicare enrollment application can be submitted (i.e. education, employment history, personal and professional information, licensure, etc.). Failure to supply ALL requested information will hold up your provider’s Medicare enrollment (and the reimbursement that goes with it).
How will PECOS benefit your practice?
The PECOS Medicare enrollment system was implemented online to replace their massive paper, mail-in applications (you can still opt to fill out a paper application form, at least for now). If you’re on the fence about which method to choose, consider the many benefits of using PECOS:
- Easy navigation. PECOS offers an easy way to view and change enrollment information, update and revalidate providers, save your application progress and manage multiple forms and documents without piles of paperwork.
- Minimize errors. PECOS ensures you will always use the correct enrollment form and have a lower chance of omitting information. Also, filling out the application electronically will eliminate messy, illegible handwriting holding up your enrollment.
- Faster processing. PECOS applications process about twice as fast as paper forms. Plus, you don’t need to print and mail any paperwork and you can track the application progress online.
While the benefits of utilizing the PECOS Medicare enrollment online site are many, it is critical that you master its nuances. You must take the time to get used to the interface, read all the headings, and pay attention to what you are doing—don’t impatiently click ahead or you might miss something important.
TIP: Mandatory fields are marked with a red asterisk, but there are instructions under each heading that you must follow to avoid making a mistake.
Why do you need an I&A account?
There are a lot of tasks to juggle when you enroll with Medicare. For example, if you plan to use PECOS Medicare enrollment online, you must first create an account with the CMS Identity & Access Management (I&A) System.
With your I&A account you can:
- Apply for a National Provider Identifier (NPI), which you need to enroll in PECOS
- Access the National Plan and Provider Enumeration System (NPPES)
- Enroll in PECOS and then update and revalidate your account information
- Access EHR incentive programs, manage staff and authorize others to access your information
Make no mistake, setting up an I&A account is more than just a stepping stone to your Medicare enrollment process. An I&A account allows you to be designated to manage your providers’ accounts in CMS systems. That in itself can be a little tricky as you will need to comply with Medicare enrollment regulations or risk payer deactivations.
How often will PECOS need to be updated?
After CMS processes and approves your initial PECOS Medicare enrollment application, that is not the end of your interaction with the site. Knowing how to correctly utilize the system and keep up with the site changes is an ongoing process to ensure your providers stay in good standing with Medicare and their claims are processed without delay.
Once your provider is approved as a Medicare provider, there are two primary functions that PECOS can help you with:
1. Information Changes/Updates:
It is extremely important that you keep your PECOS accounts up-to-date and accurate. Any time there is a change related to your provider or practice you’ll need to update your PECOS accounts. You are required to make these changes within 30 days of the event. If not, you risk having your provider’s Medicare billing privileges revoked. Some of the items you’ll be required to update include:
- Practice ownership, legal structure and name
- Adverse legal action
- Exclusions, revocations or suspensions
- Practice location and mailing address
- Termination of Physician Assistant employment
- Electronic Health Record systems
- Billing agency
- User titles (Authorized Officials, Access Managers, Staff End Users, Surrogates)
- Reimbursement bank account
- Patient home services
- Liability insurance
You will also need to periodically revalidate your provider’s enrollment – approximately every 3 to 5 years. Revalidation is just a fancy word for renewing, and CMS requires this formality in order to keep your Medicare billing privileges active. When it is time to revalidate your account, you will receive an email notification and a deadline of when it must be completed.
When you use the PECOS Medicare enrollment site, you can revalidate your provider’s status as well. You’ll be asked to review the information on file for your provider and practice. You may be asked to update something that has expired – like licenses or insurance. Once you’ve reviewed all of the information and updated/uploaded any required information, you’ll be asked to electronically sign your revalidation.
Designate an Authorized Official
Rarely do providers want to take the time to manage their own PECOS accounts. This usually falls to you. In many instances, your provider may just give you her username and password and ask you to keep it up to date, but this is not recommended. Instead, your provider should designate an Authorized Official (AO) to work on her behalf. You can register and validate an AO in the I&A system. Once that’s complete, you can use the PECOS Medicare enrollment site on behalf of your provider.
An AO isn’t the only means to hand off a provider’s PECOS management. There are also these designations available:
- Access Manager (AM) – Same privileges as the AO, but this individual is designated by the AO whereas the AO is appointed by the organization.
- Staff end-user (SEU) – An individual or employee who can act on behalf of a provider in the CMS systems
- Surrogate – An organizational provider or third-party organization who can act on behalf of a provider in the CMS systems
Each designation has its own setup process that you must follow to remain compliant with CMS.
Get PECOS Medicare Enrollment Help Now!
Even though PECOS eliminates the burden of you having to manage the mounds of paperwork involved in your Medicare enrollment applications and their related documents, the process is still time-consuming, complicated and confusing!
Utilizing PECOS correctly means juggling multiple moving parts and understanding how to correctly manage the nuances of the system. There are numerous circumstances that can derail your Medicare enrollment. You must manage these nuances correctly for your enrollment to be in good standing.
One of the most confusing aspects of PECOS is setting up and utilizing a surrogacy account so that you can manage your providers more easily and compliantly. The good news is you can receive help from enrollment expert, Gretchin S. Heckenlively, CPA, FHFMA. During her 90-minute online training PECOS: Master CMS Surrogacy Enrollment Requirements you’ll learn how to successfully set up and maintain a surrogacy account for your Medicare providers.
Don’t wait another minute. Sign up for the PECOS surrogacy online training today!
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