If you were not already aware, CMS is implementing an Internet-based Medicare provider enrollment process, known as the Provider Enrollment, Chain and Ownership System (PECOS). For any service or item to be covered by Medicare, it must be ordered by a physician or a practitioner who a) is eligible to order such items, b) is enrolled in PECOS, and c) for DMEPOS items, must be indicated in PECOS as specialty eligible to order DMEPOS items for Medicare beneficiaries, reference (SSA section 186(r) and 1842 (b)(18)(c)).

If you are not enrolled in the Medicare program, or if you enrolled more than 5 years ago and have not submitted any updates or changes to your enrollment information in 5 years, you do not have an enrollment record in PECOS.

The Centers for Medicare & Medicaid Services (CMS) previously announced that, beginning January 3, 2011, if certain Part B billed items and services require an ordering/referring provider and the ordering/referring provider is not in the claim, is not of a profession that is permitted to order/refer, or does not have an enrollment record in the Medical Provider Enrollment, Chain and Ownership System (PECOS), the claim will not be paid.

***CMS has recently announced that automated edits will not be turned on effective January 3, 2011. CMS is working to resolve enrollment backlogs and other system issues and will provide ample advanced notice to the provider and the beneficiary communities before they begin any automatic nonpayment actions. It is expected that sometime in 2011 the PECOS requirement will become effective, so it is very important that physicians enroll as soon as possible. To continue to order DMEPOS for Medicare beneficiaries you will need to enroll in the Medicare program or "revalidate" your Medicare enrollment information.***

For additional information regarding the Medicare enrollment process, including Internet-based PECOS, please visit: http://www.cms.hhs.gov/MedicareProviderSupEnroll