Enrollment submission of PECOS

who is new patient - Medicare rule of group practice

The Medicare Claims Processing Manual (Chapter 12, Section 30.6.7) now defines “new patient” for the E/M visit code and reads as follows.

Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years. For example, if a professional component of a previous procedure is billed in a 3-year time-period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

PECOS

can i submit PECOS application via paper or only internet

Am I required to complete and submit my Medicare enrollment application via Internet-based PECOS?

No. Physicians and non-physician practitioners continue to have the option to complete and mail the paper Medicare enrollment application to the appropriate Medicare contractor.

Information required for PECOS enrollment submission

Information required for PECOS enrollment submission

What information will I need before I begin to complete my enrollment via Internet-based PECOS?

below is a list of the types of information needed to complete an initial enrollment action using Internet-based PECOS. This information is similar to the information needed to complete a paper Medicare enrollment application.

    *   An active National Provider Identifier (NPI).

    *   National Plan and Provider Enumeration System (NPPES) User ID and password.

    *  Personal identifying information. This includes legal name on file with the Social Security Administration, date of birth, Social Security Number

    *   Professional license and certification information. This includes information regarding the physician's or non-physician practitioner's professional license, professional school degrees or certificates.

advantages of Internet-based PECOS

why online PECOS submission is good and what we can do

What are the advantages of Internet-based PECOS?

There are a number of advantages to using Internet-based PECOS, as opposed to mailing in your application.  These advantages include the following:

    * Faster than paper-based enrollment (7 day processing time in most cases)

    * Gives you more control over your enrollment information, including reassignments

    * Easy to check and update your information for accuracy

    * Less staff time to complete and submit enrollment information to Medicare

Provider Enrollment, Chain, and Ownership System (PECOS)

Providers and suppliers must have Internet Explorer version 5.5 or higher and have the most recent version of Adobe Acrobat Reader before initiating an enrollment action using Internet-based PECOS.

The Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) can be used in lieu of the Medicare enrollment application (i.e., paper CMS-855) to:

• Submit an initial Medicare enrollment application
• View or change your enrollment information
• Track your enrollment application through the web submission process
• Add or change a reassignment of benefits
• Submit changes to existing Medicare enrollment information
• Reactivate an existing enrollment record
• Withdraw from the Medicare Program

Advantages of Internet-based PECOS

• Faster than paper-based enrollment (45 day processing time in most cases, vs. 60 days for paper)
• Tailored application process means you only supply information relevant to YOUR application
• Gives you more control over your enrollment information, including reassignments
• Easy to check and update your information for accuracy
• Less staff time and administrative costs to complete and submit enrollment to Medicare