Physicians may enroll or make a change in their Medicare Part B enrollment information through the Web-based Provider Enrollment, Chain and Ownership System (PECOS).
According to CMS, all physicians who enrolled with Medicare prior to March 25, 2011, will be required to revalidate their Medicare enrollment. Physicians have 60 days from the date of the revalidation notice to submit their complete enrollment information. You will receive a green letter through the mail when it is your turn. Failure to submit a completed enrollment application — including all supporting documentation — within the 60-day timeframe may result in Medicare billing privileges being deactivated.
Enrollment and Change of Ownership Denials Due to Overpayments
Medicare contractors may now deny a Form CMS-855 enrollment application if the current owner of the enrolling provider or supplier or the enrolling physician or non-physician practitioner has an existing or delinquent overpayment that has not been repaid in full at the time an application for new enrollment or Change of Ownership is filed.
New 855R Form Mandatory June 1, 2015
CMS has a revised 855R application that physicians may start using at this time. Beginning June 1, 2015, this new version will be required and the older forms will be rejected. The current form is identified as 855R (07/11), whereas the new version will be noted as 855R (11/12). According to the MLN Matters Article SE1432, the revised CMS 855R has been streamlined and some sections have been re-ordered for clarity.
Provider Enrollment and Certification Tips
When submitting on paper, either by fax or mail, Medicare has 60 days to process your application. Be sure to choose one method of submitting. If duplicate applications are submitted (one by fax and one by mail), this can slow the process down and take longer than 60 days to process.
If you choose to submit via Internet-based PECOS, the application should be approved in 45 days. With that, CMS encourages providers to choose the Internet-based PECOS system to enroll.
You can start to see patients on the date you enter on your application as the “effective date.” Most practices will hold claims until the application is approved and then submit.
Verifying Enrollment and Validation
You can go to Ordering and Referring Report to verify if your name and NPI is present. This file is updated every two weeks. If you are not enrolled, visit the CMS website to learn how. All enrollment applications, including those submitted over the Internet, require verification of the information reported. Sometimes, Medicare enrollment contractors may request additional information in order to process the enrollment application. Waiting too long to begin this process could mean that your enrollment application may not be processed prior to the implementation date of the ordering/referring Phase 2 provider edits
Is Your PECOS Data Accurate?
Physicians must check their PECOS data to assure accuracy for CMS claims payment and PQRS reporting. To delay could result in lack of payment. Information such as address, NPI and name of practice must be confirmed. Check by physician or practice.
Resources from the Academy
Resources from CMS
Resources from Cahaba