As a result of the Patient Protection Affordable Care Act and a CMS issued Interim Final Rule effective July 6, 2010, physicians who have not enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) as participating, non-participating or opted-out-of physicians will not be permitted to order or refer patients for Medicare covered home health services. PECOS is the enrollment system for Medicare providers and suppliers. If you enrolled in Medicare prior to 2003, and you have not submitted any updates to your Medicare enrollment information since then, you do not have a file in PECOS.
Effective July 6 2010, if you do not have an approved enrollment record in PECOS, Medicare will not pay for your patients' home health services. This could mean that your patients may not have access to home health care when prescribed by you.
If you do not have an approved enrollment record in PECOS, it is imperative that you immediately begin the process. Medicare contractors have up to 45 days to process internet enrollment applications, and 60 days to process paper enrollment applications from the date of receipt of the signed and dated two page Certification Statement and the supporting documentation.
You have two options to submit your enrollment application:
(Option 1) Use Internet-based PECOS
Step 1. Before you begin, be sure you have a National Provider Identifier (NPI) and have created a User ID and password in the National Plan and Provider Enumeration System (NPPES). You will need the NPPES User ID and password in order to access Internet-based PECOS. If you need help creating an NPPES User ID and password, or if you are not sure you ever created them or cannot remember what they are, you may contact the NPI Enumerator for assistance at 1-800-465-3203.
Step 2. Read the documents that are available about Internet-based PECOS on the CMS Provider/Supplier Enrollment web page (www.cms.hhs.gov/MedicareProviderSupEnroll)
Step 3. Once you have completed and submitted your enrollment application using Internet-based PECOS, be sure to print the Certification Statement, sign and date it, and mail it, along with any required supporting documentation, to the carrier or A/B MAC whose name and mailing address will be displayed to you by the system.
Note: If you reassign some or all of your Medicare benefits to a group practice, there will be two Certification Statements to print, sign and date, and one of them will also need to be signed and dated by an Authorized Official of the group practice. The carrier or A/B MAC cannot process your web-submitted enrollment application without having the signed and dated Certification Statement(s) in hand.
(Option 2) Complete the paper Medicare enrollment application (CMS-855I) as an initial application.
Step 1. Complete the CMS-855I (if you reassign benefits to a clinic or group practice other than your own, complete a CMS-855R as well), sign and date (blue ink recommended) and mail the application(s), along with any required additional supporting documentation, to the Medicare carrier or A/B MAC. These forms are downloadable from the CMS Provider/Supplier Enrollment web page (shown above) or the CMS forms page www.cms.hhs.gov/cmsforms, or you may request the necessary forms from the carrier or A/B MAC.
Step 2. Once the paper application has been received by the carrier or A/B MAC, the carrier or A/B MAC will begin to process your enrollment application. If additional information is needed by the carrier or A/B MAC to complete the processing of your enrollment application, they will contact you.
If you need information about Medicare enrollment or how to use Internet-based PECOS, visit the CMS Provider/Supplier Enrollment web page at: http://www.cms.gov/medicareProviderSupEnroll/.
If you need assistance with your NPPES User ID and password, contact the NPI Enumerator at 1-800-465-3203.