MGMA In Practice blog

By Jaclyn Julian
Project Manager, Public Affairs & Advocacy

Medical practices have long suffered with a cumbersome Medicare provider enrollment process. As an alternative to the paper enrollment form (CMS-855), the Centers for Medicare & Medicaid (CMS) developed the Internet-based Provider Enrollment, Chain and Ownership System (PECOS).

But using the online option presents its own challenges – including an upcoming deadline to enroll your physicians.

In a May 5 interim final rule, CMS moved the deadline for all ordering/referring physicians to be in the PECOS enrollment database. This means:

• Starting July 6, Part B claims for covered laboratory, imaging and specialist services require the identification of the ordering or referring physician.
• If the legal business name and National Provider Identifier of the ordering/referring physician is not on the claim – or the ordering/referring physician does not have an approved record in PECOS – the claim will be rejected and payment will be denied.

MGMA and the American Medical Association partnered to develop a toolkit that explains how to enroll your practice and clinicians with as little hassle as possible.

• Learn when to enroll, and let the checklist guide you through the application process.
  
• Understand how to use Internet-based PECOS to enroll, check your enrollment status and view your enrollment information.
  
• Discover how the recent changes to Medicare provider enrollment affect your medical practice.

• Identify common mistakes that providers make when completing the Medicare provider enrollment applications.

Download the member-only Medicare Provider Enrollment Toolkit (login required)
(Not a member? Join today!)

To help you meet changes in compliance, attend MGMA's Webinar, "Medicare Enrollment and PECOS Overview: Changes and Impact on Compliance and Cash Flow."

Plus, find out how MGMA is advocating for our members on Medicare provider enrollment and PECOS.

Your turn. What are your pain points with the process? Tell us in the comments.