Are You Prepared for the May 1st PECOS Edits?

After a brief announcement and retraction, CMS settled on May 1, 2013, as the day that phase two of the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) will go into effect.

As of that date, CMS will deny HME, Part B, and Part A home health agency claims that are prescribed by health care professionals who are not enrolled in the PECOS system.

 Phase one of the PECOS system began on October 5, 2009. At that time, CMS started warning HME providers who were submitting claims ordered by clinicians who were not yet enrolled in PECOS.

Due to the extremely high number of warnings that HME providers were receiving, AAHomecare immediately asked CMS to take a much more measured approach and delay the start of phase two until data showed that the vast majority of ordering clinicians were enrolled in the system.

“CMS indicates that they have taken proactive steps to enroll ordering and referring providers,” say AAHomecare officials in a message to members. “By their estimates, less than one percent of ordering clinicians have not enrolled in PECOS. 
HME providers can avoid unnecessary denials by ensuring that they submit claims using the individual clinician NPI rather than the organization NPI.

Retreived from
March 11th, 2013