Author: Lance Hebert, Vice President, Ambulatory and Post-Acute at Verity, A HealthStream Company
Submitting a PECOS enrollment application comes with its own set of frustrations, and the consequences of incorrectly submitting an application can cause even greater headaches and cost your organization time and money. The following simple steps can help you avoid those mistakes that freeze payments for services that have already been provided and lead to a successful filing the first time.
Before beginning the application process, make sure that you have all the information you need to file in front of you. A common mistake is to start working on an application but have to step away to search for required information that is not on hand. The PECOS system times out after 15 minutes of inactivity, and if your work is not saved you will lose your progress and be forced to restart the process.
Submitting your application outside of the correct window of time is a common cause for rejection. If you turn in your submission outside of the 60-day timeframe, your application will be rejected and you will have to start over. In addition, if you are late submitting your application and your provider has already begun providing services, you are at risk of missing a valuable billing period.
One of the easiest steps to ensure a successful enrollment is to eliminate application errors. Mistyping or incorrectly writing information on a manually completed application is a common mistake that can be avoided. The easiest way to eliminate the risk of those errors is to use a source of truth database and software that will automatically populate the fields into PECOS for you.
Errors of omission are another common cause of rejected applications when the Medicare application is filled out manually and sent in. The use of PECOS will eliminate these errors because the system will not let you submit the application if there are incomplete fields or if required documents have been omitted.
Additionally, before submitting your application, make sure that you input the correct zip code plus the four-digit extension with the address. Medicare has emphasized that an incorrect zip code or a failure to include the four-digit extension is cause for rejection. Again, if you already have this information as your source of truth in your database, the database will automatically populate this field for you, saving you time and the risk of error.
The more automation in your Medicare enrollment process, the more time you save, less errors you make, and the more likely your application will be approved the first time.
Successful acceptance of your application relies on the submission of the correct forms. This may seem like an uncommon mistake, but submitting the wrong form is a common error when manually submitting forms for a new provider. Using a database eliminates the problem of identifying which applications are required for various types of submissions. For example, if you have a new provider that is joining your practice, you would need to complete a CMS-855i for the initial enrollment and a CMS-855R to reassign the provider’s benefits to you.
A benefit of using PECOS is that the built-in smart technology automatically enables the correct forms to be pulled for completion based on your responses to the initial series of questions. The system is able to determine what type of enrollment is required and ensure that the corresponding information is collected.
Finally, remember that by using PECOS, you can log into the system to check on the status of your application, respond to development requests, and input additionally requested information directly in the system. And if you use a source of truth database, it will alert you of submission deadlines and allow you to access all application information and requests through a single system, streamlining the process.