Enrollment Risks and Consequences — Costly PECOS Mistakes You Could be Making Every Day

Enrollment Risks and Consequences — Costly PECOS Mistakes You Could be Making Every Day

Oct 11, 2018
  • Author:
    Lance Hebert, MCSE, MCP
    VP, Ambulatory and Post-Acute
    Former VerityStream Employee

As an alternative to paper-based enrollment forms, the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) supports the Medicare Provider and Supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information. Using PECOS, providers and suppliers can:

  • Submit Medicare enrollment applications
  • View and print enrollment information
  • Update enrollment information
  • Complete the enrollment revalidation process
  • Withdraw from the Medicare Program voluntarily
  • Track the status of a submitted Medicare enrollment application

The Advantages of Internet-based PECOS

PECOS is part of CMS’s effort to automate the provider enrollment process and get away from using paper forms. Already, they have set a deadline beyond which they will not accept paper forms that have been filled out by hand. CMS lists the following advantages of using PECOS for providers:

  • Faster than paper-based enrollment (45 day processing time in most cases, vs. 60 days for paper)
  • Tailored application process means you only supply information relevant to YOUR application
  • Gives you more control over your enrollment information, including reassignments
  • Easy to check and update your information for accuracy
  • Less staff time and administrative costs to complete and submit enrollment to Medicare

Two Significant PECOS Mistakes That Can Have a Serious Impact

The benefits of online enrollment are readily apparent, from quicker processing and less time involved to easier, automated status updates and being able to bill for services sooner. It is important, however, to be aware of two of the major risks involved in using the system.

  1. Compliance Risks

  2. Filling out forms online doesn’t lessen the importance and necessity for all information provided to be correct. An authorized official at your organization is legally bound by every part of the provider enrollment submission through PECOS. A best practice is to make sure that your legal department reviews every submission and attests to its accuracy. If information needs to be corrected, delaying a provider’s enrollment, your organization will need to repay what a provider has billed and been paid. Mistakes in this area can be accidental or deliberate—penalties will be far more substantial if found to have occurred on purpose.

  3. Enrollment Timeline Errors

  4. There is an established enrollment timeframe applicable to every provider that is very important for billing purposes to ensure you can bill from the provider’s start date forward. If you submit outside this window you will not be able to bill for their services. Furthermore, if you submit an application with errors that is then returned for corrections, you will have only a certain number of days to make them and resubmit. Failing to meet that timeframe requires you to start the application process over again. Starting over can put money at risk for services that have been provided for which Medicare cannot be billed. You really have to pay attention to the application and any subsequent follow up requests for information that you get from the Medicare administrative contractor.

Additional PECOS Risks to Know About and Avoid

One mistake to avoid is submitting your application with errors involving the zip code plus four digit extension. If you don’t include the proper code with your application or fail to add the valid plus four digits, that is a cause for rejection about which Medicare has been very strict during the past year. Other mistakes that can lead to rejection involve misspelling and user errors related to manual typing and retyping of forms. It is human nature to make mistakes when completing each form by hand, even online. Here again, whenever correction is requested, it is vitally important that you stay within the appropriate timeline for responses.

PECOS has significant potential value for automating provider enrollment for Medicare. Like any tool, however, using it successfully requires knowledge and preparation. Understanding how the system works best and what common pitfalls to avoid can help you prevent enrollment headaches for providers and your organization, as well as support better financial performance.