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Linda Collins Blogger

PECOS and DMEPOS

Posted by Linda Collins | June 05, 2014

The Provider Enrollment, Chain and Ownership System (PECOS) is a database of physicians who are enrolled with Medicare. When a physician prescribes an item, such as an OA Knee brace, the supplier must list the physician’s National Provider Identifier (NPI) number on the claim. The NPI number links to the physician’s provider file in the PECOS system.

In order for a DMEPOS item to qualify for coverage by Medicare, a physician or a practitioner who is eligible to order such item must write the prescription. To be eligible the physician must meet these requirements:

1. Physicians or practitioners have registered in PECOS.

AND

2. Have a specialty that is eligible to order DMEPOS items for Medicare beneficiaries.

The provider specialties eligible to order DMEPOS items include:

  • Doctor of Medicine or Osteopathy
  • Doctor of Dental Medicine or Dental Surgery
  • Doctor of Podiatric Medicine
  • Physician Assistant
  • Certified Clinical Nurse Specialist
  • Nurse Practitioner
  • Doctor of Optometry

What does this mean for you?

Verify that your referring physicians are Medicare eligible to prescribe the DMEPOS item. A simple resource for verifying status is http://www.oandp.com/pecos/. You can check the CMS ordering/referring physicians downloadable report that contains the NPI, first name, and last name of providers enrolled in PECOS. This report is accessible on the CMS Web site at: www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/MedicareOrderingandReferring.html.

Enter the physician’s NPI number and name, exactly as it appears in PECOS, on all claims.

Contact your MAC for any additional information you may need.

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