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David McGill Blogger

May 1: Another Way to Get Your Medicare Claim Denied

Posted by David McGill | April 19, 2013

​"Provider Enrollment Chain & Ownership System." 

Rolls right off the tongue, no?

The acronym "PECOS" has floated around O&P the last few years. But effective May 1, it directly affects your ability to receive Medicare payments.

Beginning then, Medicare will "flip the switch" that automatically denies DMEPOS claims resting on a prescription from a doctor who hasn't yet enrolled in PECOS. In other words, starting May 1st your prescribing physician must be in the PECOS system if you want to get paid. 

What does this mean to me?

Adding one new step to your pre-claim process will protect you from a "PECOS denial." For all claims submitted on May 1 or later, confirm that your prescribing physician/practitioner has already enrolled in PECOS. 

Medicare has a downloadable list of all PECOS-enrolled physicians/practitioners available here. The download is available as both a PDF and Excel file. (The PDF is 21,000+ pages long. I searched for my doctor's name using the "find" function and it located him in less than 10 seconds.)

 

If the prescribing doctor/practitioner appears in Medicare's PECOS database, you should be able to file your Medicare claim without fear of a PECOS denial.

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