Avoiding Rejected Applications – Correct Form Version?

For providers and suppliers that utilize the Medicare enrollment application forms, in lieu of Internet PECOS, it is important to confirm the current version of each form prior to its completion and submission. This can be particularly important when completing forms in advance of a pending transaction or the opening of a new business, especially when delays affect timing for submitting the application packet.

For example, effective January 1, 2017, CMS requires the use of the May 2016 version of the CMS 855S form. (more…)

Hospital Payment Delays for Unreported Practice Locations

The revalidation process and increased sanctions for non-compliance with the requirements to update Medicare enrollment has not succeeded in ensuring all providers understand the importance of having accurate Medicare enrollment data. And, some providers mistakenly believe that all of the provider’s practice locations must have been reported since claims were being paid.  CMS’ historic purposeful separation between Medicare enrollment data in PECOS and claims data in FISS facilitated that misunderstanding.  Effective as of January 1, 2017, that will change. (more…)

Don’t Hesitate — Revalidate

Revalidation efforts are underway again, but this time for all providers and suppliers. When CMS revised the Medicare enrollment rules in June 2006, one change was to require each provider or supplier to revalidate its enrollment at least every 5 years. The initial revalidation efforts, which began in 2007, focused on providers and suppliers that had enrolled prior to 2003, when CMS had fully implemented the PECOS database for maintaining Medicare enrollment data. This article contains information on the revalidation process and tips for preparing revalidation forms.


Medicare Enrolled Providers – Is Your PECOS Data Current?

Sanctions for Failure to Provide Timely Updates

Although Medicare-enrolled providers and suppliers historically were required to provide notice of changes in enrollment data, prior to the Medicare enrollment rule changes in June 2006, there were no sanctions for failing to do so. Effective June 2006, CMS changed its rules to allow the imposition of sanctions for failing to provide timely notification of changes in enrollment data. With sanctions now in place, it is important for enrolled providers and suppliers to understand the duty to report changes in enrollment information and the time frames for reporting such changes.


PECOS Basics

PECOS, the Provider Enrollment, Chain, and Ownership System, is a national electronic database for recording and retaining data on Medicare-enrolled providers and suppliers. CMS developed PECOS as a mechanism to combat fraud and abuse. When it proposed its plan to launch the use of the PECOS database in October 2001, CMS announced “it will now be possible to link providers/suppliers to the people and organizations with which they have a business relationship and to identify those involved in illegal Medicare activities.”