Announcement Detail

New Requirements For MEDICARE Physicians Internet-Based Medicare Enrollment - Effective Date 4/5/10

1/27/2010 -
NEW REQUIREMENTS FOR MEDICARE PHYSICIANS
INTERNET-BASED MEDICARE ENROLLMENT
Effective Date April 5, 2010CR 6417 

Doctors who order Medicare services or refer patients for such services have until April 5, 2010 to determine whether they are up to date in CMS’s Provider Enrollment, Chain and Ownership System (known as PECOS).  CMS has warned that it will stop paying claims on this date for those who have not complied with the new enrollment policy.

If a doctor lists a referring physician on a claim for a particular patient and that referring physician is not in PECOS, the billing physician will not get paid.  Many physicians who originally enrolled in Medicare before 2003 are not currently enrolled in PECOS, when CMS started using this system.

 

Doctors who are not currently in the PECOS system will need to re-enroll with Medicare. CMS is recommending that all physicians ensure that their enrollments are up to date and compliant by contacting their Medicare contractors or viewing their records online. A current record is one that is in the PECOS database with all the correct information.

 

CMS says the re-enrollment process is simple, but the penalty for not updating the records with Medicare can be severe.  Re-enrollment can be accomplished using either the paper enrollment application process (e.g. CMS-855I) or the Internet-based PECOS system.

Internet-based PECOS

The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) allow physicians to enroll, make a change in their Medicare enrollment, or view their Medicare enrollment information on file with Medicare.           

Internet-based PECOS is a scenario-driven application process with front-end editing capabilities and built-in help screens. The scenario-driven application process will ensure that physicians complete and submit only the information necessary to enroll or make a change in their Medicare enrollment record.  

There are three basic steps to completing an enrollment action using Internet-based PECOS.  Physicians must: 

 
  • Go to Internet-based PECOS at https://pecos.cms.hhs.gov and complete, review, and submit the electronic enrollment application via Internet-based PECOS.
 
  • Print, sign and date the two-page Certification Statement and mail the Certification Statement and all supporting paper documentation to the Medicare contractor within 7 days of electronic submission. 

Note:  A Medicare contractor will not process an Internet enrollment application without the signed and dated Certification Statement.  In addition, the effective date of filing an enrollment application is the date the Medicare contractor receives the signed Certification Statement that is associated with the Internet submission.    While CMS encourages physicians to print and retain a copy of the enrollment record for their records, physicians should only mail the two-page Certification Statement to the designated contractor. 

Additional Information 

For information about Internet-based PECOS, including important information that physicians should know before submitting a Medicare enrollment application via Internet-based PECOS, go to www.cms.hhs.gov/MedicareProviderSupEnroll.



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