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Enroll in PECOS to ensure acceptance of DME claims
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 Charles B. Brownlow |
If you are writing prescriptions (orders) in your practice for post cataract glasses, aphakic glasses or contact lenses or for any other materials considered durable medical equipment by Medicare, your name and National Provider Identifier must be registered in the federal government’s Internet-based Provider Enrollment, Chain and Ownership System. If your office fills prescriptions for other optometrists or ophthalmologists for Medicare patients’ glasses or contact lenses, those doctors must also be registered.
It is not enough to have a National Provider Identifier (NPI) and it is not enough to be a participating provider in Medicare. You must be registered in the Provider Enrollment, Chain and Ownership System (PECOS) or your claims for durable medical equipment (DME) will be rejected beginning in January 2011.
You may check to see if you are already listed in PECOS by contacting your local Medicare carrier or by going online to http://www.cms.gov/MedicareProviderSupEnroll/01_Overview.asp, and then to the box on the left of the page to “OrderingReferringReport.” Scroll down to the “Downloads” section and hit “Medicare Ordering and Referring File.” When you open that section (it may take several minutes, as it includes 700,000 names), look for your name, listed individual NPI/last name/first name. If you find your name on that list, breathe a sigh of relief.
If you do not find your name on that list, continue in the same section to “Initial Physician Applications Pending Contractor Review” to see if you are in there. If your name is not there either, go to the box on the left of the main page to “Enrollment Applications” and submit your application online or on paper. The enrollment form that will apply to most optometrists is 855I.
Some local Medicare carriers are quite helpful in assisting with the PECOS enrollment process if you are confused or if you try and fail to register online. They are there to help you, so do not be shy about contacting provider relations folks at the carrier. You may also contact your professional association for assistance with your registration.
- Charles B. Brownlow, OD, FAAO, is a member of the Primary Care Optometry News Editorial Board and a health care consultant. He can be reached at PMI, LLC, 321 W. Fulton St., P.O. Box 608, Waupaca, WI 54981; Brownlowod@aol.com.