What is PECOS?
PECOS stands for Provider, Enrollment, Chain and Ownership System. It is a database where physicians register with the Centers for Medicare and Medicare Services (CMS).
CMS developed PECOS as a result of the Patient Protection and Affordable Care Act. The regulation requires all physicians who order or refer home healthcare services or supplies to be enrolled in Medicare – or have officially opted out – and registered in PECOS.
Effective January 6, 2014, CMS started to deny claims for Medicare home health services or supplies from all physicians not registered in PECOS. Physicians who care for Medicare patients should enroll in PECOS to ensure their patients can receive the care and supplies they need.
What does it cost?
I’m already enrolled in Medicare, do I need to enroll with PECOS also?
YES! You must enroll with PECOS. If you have enrolled with the program since 2003 you may already be in the system. However, it is very important to your patients that you verify your PECOS status. Otherwise, they may not receive the items you prescribe.
What if I don’t want to be enrolled in Medicare?
In PECOS, you have the option to opt out of Medicare. This way, you will be able to continue ordering home healthcare services for your Medicare patients.
I have an NPI number, am I in PECOS?
Probably not. Your National Provider Identification (NPI) is not registered with the PECOS system until you complete the registration process.
What if I don’t have a National Plan & Provider Enumeration System (NPPES) login or need help changing my password?
Contact the NPI Enumerator at: 1-800-465-3203 or [email protected]
What if I don’t bill for Medicare? Do I still need to enroll in PECOS?
In some circumstances, a physician may order and refer home health services, but not bill for Medicare. These physicians are still required to be enrolled in PECOS.
When I submit an application, am I automatically approved?
The Medicare contractor will review your application to determine whether you meet all of the requirements for enrollment.
What other professionals must register with PECOS?
- Physician Assistants
- Certified Clinical Nurse Specialists
- Nurse Practitioners
- Clinical Psychologists
- Certified Nurse Midwives
- Clinical Social Workers
What happens if I do not register?
Any claims for items or services that you have prescribed will be denied if you are not in the PECOS system. This applies to Medicare claims only. Not being in the PECOS system will make it difficult for your patients to receive the items they need and will prevent/delay hospital discharges.
Also, you may have previously prescribed items that are being rented. These items can go back three years or more (oxygen for example). These claims will also be denied if you are not registered with PECOS.