PECOS Check
If you’ve been a part of the DME industry for any amount of time, you’ll know that nothing ever stays the same. As with many areas of the healthcare continuum, DME has seen its fair share (possibly more) of policy and regulatory changes over the years.
In 2022 CMS changed the agency responsible for processing applications and credentialing DME providers, moving the responsibilities from The National Supplier Clearinghouse to two separate contracted agencies. These two agencies have essentially split the country in half at the Mississippi River to define their states of responsibility. While establishing the two new contractors, CMS also announced the creation of a third and separate agency that will have a single focus for their provider reviews, which is state licensure.
Standard #1 of the Medicare DMEPOS Supplier Standards states 'if a State requires licensure to furnish certain items or services a DMEPOS supplier must be licensed to provide the item or service'.
We’d like to ask you, when was the last time you checked your Provider, Enrollment, Chain, and Ownership System (PECOS) enrollment information for all of your Provider Transaction Access Numbers (PTAN)? Are they all registered for only the states they service and are you ensuring that those locations are not servicing outside of their approved product and location designations? If you haven’t reviewed this important detail, you’ll want to make it a priority in the very near future. CMS has noted that the new agency will review claim detail in comparison with the PECOS registration information available for the servicing provider. If the provider is found to be in violation of the Supplier Standards, the contractor has been authorized to suspend the provider PTAN and revoke Medicare billing privileges.
If you needed to do a Google search to see what the PECOS and PTAN acronyms meant, you are not alone. However, ignorance is no defense when dealing with CMS regulations. STAR Medical Auditing Services has a dedicated DMEPOS Expert on staff that can assist you with this and other regulatory issues surrounding DME billing. Reach out to learn more!
References:
https://www.palmettogba.com/palmetto/npewest.nsf/DID/CHEQ4E0825
