pecos medicare enrollment: master it to speed up your approval · pecos medicare enrollment: master...

Training Session Handouts

PECOS Medicare Enrollment: Master It To Speed Up Your Approval

Presented by: Chastity Werner, RHIT, CMPE, CRCR, NCP

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PECOS Medicare Enrollment: Master It to Speed Up Your Approval

www.hctrainingleader.com 1

Completing and Managing Your

Medicare Enrollments Best Practices

Presented by: Chastity Werner, CMPE, RHIT, CRCR, NCP

Completing and Managing Your Medicare EnrollmentsBest PracticesDid you know if you do not update your Medicare enrollment applications within 30 days of certain changes made in your organization, your Medicare billing privileges could be revoked? Or that by the end of 2019, Medicare will no longer accept handwritten applications? Over the past several years Medicare has made some great changes in their enrollment processes. It wasn’t that many years ago, it could take 30 if not 60 days to enroll a provider. Today, the process is streamlined and automated. In some cases, you can apply and have a provider enrolled within days! This is exciting news for our healthcare providers, especially is Medicare is one of your larger payers in your payer mix. In order to achieve this as an organization, you must utilize all the Medicare enrollment systems and tools (Identify & Access, PECOS, & NPPES). Once set-up, the process is streamlined and automated, however, setting up the process can at times be cumbersome, overwhelming and intimidating. Especially if your staff has never utilized the systems. This training, we will discuss best practices for managing Medicare Enrollments and using the PECOS system on an ongoing basis.

The intended audience is hospital Medicare Billers and other Financial Leaders .2



Learning OutcomesBy the end of this course, you should be able to:• Describe the role of PECOS within the Medicare enrollment process• Describe how to use other various applications within the enrollment process• Identify information that is required on the applications• Describe how to electronically complete an application in PECOS• Recall how to track your applications

Learning Outcome Standard: This course is based upon requirements from the Centers for Medicare and Medicaid (CMS) Medicare enrollment application (CMS-855 or Internet-based Provider Enrollment, Chain and Ownership System (PECOS).

3

Common ErrorsKnowledge

• Applications• Provider types• Service types

Access• Information• Provider profiles

Connections & Set-up• AO, DO, & SEUs• Provider profiles



Part One: The role of PECOS

Provider Enrollment, Chain, and

Ownership System

https://pecos.cms.hhs.gov/pecos/login.do#headingLv1PECOS FAQs ICN 909015 January 2019



Provider Enrollment, Chain & Ownership System(PECOS)

www.cms.gov/MedicareProviderSupEnroll

PECOS allows physicians and non-physician practitioners to enroll, make a change in their Medicare enrollment, or view their Medicare enrollment information on file with Medicare

It is scenario-driven application process

with front-end editing capabilities and built-

in help screens.

It will ensure only the information necessary will be completed and submitted to enroll or make a change in Medicare enrollment records.

What is PECOS?Provider Enrollment, Chain & Ownership System

• Implemented November 2003• Used by all Macs• Standardize the enrollment process• Assist Medicare as a tool to detect and fight

fraud and abuse• Improve accuracy of enrollment data• Ensures only qualified individuals and entities

are enrolled with Medicare



How to effectively utilize PECOS• Submit initial applications• View or change your

enrollment information• Track your enrollment

applications through the web submission process

• Add or change a reassignment of benefits

• Submit changes to existing Medicare applications

https://pecos.cms.hhs.gov/pecos/login.do#headingLv1

• Reactive an existing enrollment record

• Withdraw from the Medicare program

• Upload documents• Electronically sign

applications• Reduce processing time to 30

to 45 days from 60+ days• Revalidate current

enrollments

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/2019_National_Provider_Enrollment_Conference_Keynote_Presentation.pdf

Before completing enrollment in PECOS, you must have an I&A System account. Organizational providers and suppliers must designate an Authorized Official (AO) to work on their behalf in these systems.



Part Two: The PECOS Application

CMS 855 ApplicationsCMS-855A

Institutional Providers (Part A)

CMS 855B

Clinics/Group Practices and Certain Other Suppliers (Part B, non-DME Suppliers

CMS-855I

Physicians and Non-Physician Practitioners (Part B/non-DME Individuals

CMS-855R

Reassignment of Medicare Benefits (Supplemental to CMS-855I form)

CMS-855S

Supplier of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (Part B, DME Suppliers)

CMS-855O

Eligible Ordering, Referring and Prescribing Physicians and Non-Physician Practitioners (Part B, Part-D and non-DME Individuals)

CMS-20134

Medicare Diabetes Prevention Program (MDPP) Suppliers (Part B, non-DME Supplier)



What information do you need?Same information as paper application

I&A account

NPI

• Personal information (e.g. Legal name, SS#, & DOB)• Legal Business Name (LBN of provider or supplier organization• Tax Identification Number (TIN) of the provider or supplier organization• Professional information

• Professional license information • School degrees• Certificates

• Accreditation information• Surety Bond information• Specialty and secondary specialty information

You may need (depending on provider type):

What information do you need?Practice location information

Current Medical practice location

Federal, State, and local business and professional licenses, certificates, registrations specifically required to operate as a health care facility

Medical record storage information

Special payment information

Bank account information



What information do you need?

Final Adverse Actions (if applicable)

Medicare-imposed revocation of any Medicare billing privileges

Suspension, termination, or revocation of a license to provide health care by any State licensing authority or the Medicaid Program

Conviction of a Federal or State felony within the 10 years preceding enrollment, revalidation, or re-enrollment

Exclusion or debarment from Federal or State health care program participation by the Office of Inspector General (OIG) or other Federal or State offices with authority to exclude or sanction a provider

Application Fee

Application Feehttps://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/2019_National_Provider_Enrollment_Conference_Provider_Enrollment_101.pdf



You cannot …..

Change your SSNChange

Change a provider’s or supplier’s TINChange

Change an existing business structureChange

Reassign benefits to an unenrolled PECOS providerReassign

CMS can deny applications for:

• Felony conviction• DEA suspended or revoked• Medicare payment

suspension (active)• Excluded from federal

program• Insufficient capital (HHA)• False or misleading

information

• Fee not paid (including if hardship exception denied)

• Noncompliance: program requirements

• On-site review, showing noncompliance

• Temporary moratorium• $1,500 overpayment

(current) – Unless:• Approved repayment

plan• Offset or appeal• Bankruptcy



• Active NPI• PECOS username and password• Personal identifying information

• Type of Provider/Supplier• Legal Business Name (LBN) on file with

the Internal Revenue Service (IRS)• Tax Identification Number (TIN) or

Employer Identification Number (EIN)• Business Structure, Incorporation Date

and State Where Incorporated (if applicable)

• State Business license information. • State license number• Original effective date• Expiration/Renewal date• State where issued

• Certification information. • Certification number• Original effective date• State where issued

• Correspondence Information• Accreditation Information

• Date of Accreditation• Name of Accrediting Body• Type of Accreditation or Accreditation

Program• Supplier Type

Checklist for Provider or Supplier Organizations

Timely ReportingWithin 30 Days

• Change in ownership• Adverse legal action• Change in practice location• Change in AO/DO• Change in banking arrangements• Change to general supervision

Within 90 DaysAll other changes

DMEPOS must report any changes in information supplied on the enrollment application within 30 days of the change to the National Supplier Clearinghouse (NSC) 42 CFR 424.57(c)(2)

Independent Diagnostic Testing Facilities must report changes in ownership, location, general supervision, and adverse legal actions to your MAC either online, or via the appropriate CMS-855 form, within 30 calendar days of the change.

Failure to report these changes could result in the revocation of your Medicare billing privileges.

Reference: SE1617



Pecos instructions

• My Associates• Enroll• View/Update• Work on existing application• Account Management• A&I System• Revalidation Notification Center• View Applications• Start or continue revalidation application

My Associates

• Create Initial Enrollment Application• Edit/View existing enrollment

• Organization & Provider



Connected Provider

Enrollments

Corrections• Opened

• You can retract applications that have been submitted that do not have all signatures.

• Will reject 20 days after 1st submission if not submitted

• Return For Corrections• Applications that are returned by MAC for

corrections. • If not corrected within 30 days they will be

rejected by the MAC

• Rejected• If not reopened within 60 days these

applications are removed/deleted from PECOs



Part Three: Creating

New Enrollments

Creating a new enrollment

Remember it requires same information as paper application.

Front end editing and

error detector

Application Progress Bar



Organization Information



Supplier Type/PAR Status

Physical Location and “Special Payments” Address



Physical Location and “Special Payments”

Address

Medicare pays all claims via EFT, the Special Payments address should indicate where all other payment information must go:• Correspondence• Special Payments

License and Certification Information/Reassignment of Benefits



Correspondence Address

Final Adverse Legal Actions



Patient Records / Billing Agency



Contact Person

Do not forget to remove Contact Person(s)

Organization’s can have more than one Contact Person

Ownership



Change of Ownership (CHOW) Process

• Occurs when a Medicare provider has been purchased (or leased) by another organization. The CHOW results in the transfer of the old owner’s Medicare Identification Number and provider agreement (including any outstanding Medicare debt of the old owner) to the new owner. 42 C.F.R. 489.18

• Must be reported within 30 days!!!!!!!!• The transfer of corporate stock or the merger of

another corporation into the provider corporation does not constitute a CHOW.

• If the TIN number changes, it is typically submitted as a CHOW.

• A CHOW generally occurs when the assets of the company are sold.

• Purchaser must accept responsibility for ALL liabilities of the current owner.

CHOW

• Seller/Former Owner• Must complete and submit the following

sections of the CMS 855A form:• 1A, 2F, 13, and 15 or 16

• Buyer/New Owner• Must complete and submit ALL sections of

the CMS 855A form, except 2G and 2H• Must obtain NPI before enrolling• Must submit the Authorization Agreement

for Electronic Funds Transfer Form CMS 588

Electronic Funds Transfer (EFT) Authorization Agreement tells you how to get electronic payments or update existing banking information.



CHOW

Additional Documentation Required:Copy of the bill of sale or purchase

agreementAll appropriate licenses and

certifications required by their stateIRS document confirming TINArticles of Incorporation

You will still be required to upload banking documentation!

• Verification letter from bank on bank letterhead



DO NOT FORGET TO SAVE YOUR WORK!Timed Out!Save your work throughout the application process.

Inactivity on application10 mins – warning15 mins – signs out If not SAVED you will have to RESTART!



Signature Required

Remember the additional E-mail ability

AO or DO will receive email notification requesting electronic signature!



Electronic Signature

Enter• First Name• Last Name• Date of Birth• SSN• Email (notification sent to)• PIN

Signature Still Pending?

Identify if Signatures are still pending in My Associates



Enrollment Records

Utilize the Enrollment Record to reconcile your Organization and Provider information.• Confirm all information is

correct• Identify missing information



Resources

Medicare Enrollment Presentations (March 2019)https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Provider-Enrollment-Events.htmlPECOShttps://pecos.cms.hhs.gov/pecos/login.do#headingLv1A&I Systemhttps://nppes.cms.hhs.gov/IAWeb/warning.do?fwdurl=/Medicare Learning Networkhttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/ICN909015.htmlI&A System Quick Reference Guidehttps://nppes.cms.hhs.gov/IAWebContent/Quick_Reference_Guide.pdf

Resources

I&A System FAQshttps://nppes.cms.hhs.gov/IAWebContent/FAQs.pdf“Who Should I Call?” CMS Provider Enrollment Assistance Guidehttps://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/downloads/CMSProviderEnrollmentAssistanceGuide.pdfCMS Integrity Guidehttps://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019033.htmlPECOS Enrollment Examplehttps://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/PECOSWebScreenExample.pdf



Chastity Werner, CEONationwide Prescription Connection, LLC

[email protected]

Questions?

pecos medicare enrollment: master it to speed up your approval · pecos medicare enrollment: master...

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