Reprinted from the Kinnser Software Home Health Blog March 28, 2012 by Karen Brooks
Amid the myriad improvements the Medicare Provider Enrollment, Chain and Ownership System (PECOS) database system has undergone in recent years is a new program that a top expert in the field says will help health care providers stay in the Centers for Medicare and Medicaid Services (CMS) compliance, better insure themselves against denied claims and reduce the risk of fraud in the Medicare system.
The “surrogate” program will let providers approve agencies, consultants, third-party vendors or any other entity of their choosing to work on their behalf in the PECOS system – allowing them to enroll payers and keep records up-to-date without having to get approval for a National Provider Identifier (NPI) and National Plan & Provider Enumeration System login.
“It’s incredibly smart and easy,” said PECOS expert David Zetter, founder, consultant and speaker atZetter HealthCare in Harrisburg, Penn.
The program is aimed at preventing providers from sharing out their unique NPI usernames and passwords – which by Medicare policy is supposed to be kept private – to entities they hire or contract to take care of their PECOS credentials.
An entity, employee or third party vendor applies to be a surrogate, and then looks up all the NPIs of the providers they want to add to their account. The system then sends an email to the provider asking for approval. Once approved, the surrogate has the ability to access National Plan and Provider Enumeration System (NPPES), PECOS and Electronic Health Record (HER) registration and attestation should the provider allow all these areas, Zetter said.
The problem the program is trying to solve?
“Compliance, security, breaking the law,” Zetter said. “Right now, providers have to give somebody like me or someone else their user ID and password in order to get into their NPPES account or PECOS (to help with their credentialing process.) Medicare is currently turning a blind eye, but the regulations don’t really allow this. You’re in violation of their security policies by doing that, but there’s no other alternative. Ninety-nine percent of providers don’t do their own credentials.”
The program was set to go live in May, 2012, he said, but technical difficulties in the programming is delaying the rollout – which will now come at an undetermined later date.
The new program should allow home health agencies to act as surrogates for referring physicians, enrolling them in PECOS for those who have not taken the initiative to do so and helping them keep those records up to date.
“Any provider could authorize anyone to be their surrogate,” Zetter said, “but any surrogate will go through CMS/CPI vetting via their social security number and other ID information to ensure they are not excluded individuals.” This access will help agencies avoid potential denial of claims for services that were ordered or referred by a physician or other eligible professional simply for lack of an approved file in PECOS. Click to learn more.
“The surrogate program is big for any practice or group or entity that has multiple providers because it makes it easier to access all those providers files, rather than in one place having to login separately for every provider,” he said.
QUICK TIPS:
- If you decide to apply as a surrogate, make sure you contact the provider first so that he or she knows to look for the PECOS email informing them of your request to be approved. Emails slip through the cracks, and the application will only be good for a set amount of time.
- Make sure the contact email on the NPPES account is up to date, so that the email will go to the right person for approval.
