Medical Practice Management Tip: Verify Medicare Enrollment Records

A recent federal audit revealed a large amount of inaccurate records in Medicare's two main enrollment systems. Provider Enrollment, and Chain and Ownership System (PECOS) showed an inaccuracy rate of 58 percent, while National Plan and Provider Enumeration System (NPPES) was 48 percent inaccurate. In addition to the inaccuracies, auditors found that the two systems were 97 percent inconsistent. 

The Scope

Millions of health care professionals and organizations use these systems, making the inaccuracies a significant problem. Errors showed up in various data fields, including mailing addresses, practice addresses, credentials, licenses and surnames. 

The Effects

Auditors warn that even offices who are being paid for Medicare services shouldn't assume everything is alright. The Centers for Medicare and Medicaid Services (CMS) sends important information via mail, including revalidation forms. If the wrong address is on file, the physician will not receive this important enrollment form. If CMS does not receive the form within 60 days, the physician could have his or her Medicare billing privileges deactivated.

Additionally, PECOS was developed under the Affordable Care Act to allow Medicare beneficiaries a platform to compare physicians. Without accurate and up-to-date information, this system is not valuable to patients. 

Physicians are encouraged to check their Medicare enrollment information as part of regular medical practice management procedure. Check your information and make the needed revisions by logging into PECOS.

Follow this simple process.

·         Find the Manage Medicare and Account Information section.

·         Click on "My Enrollments."

·         Find the Existing Associations section.

·         Click on "View Enrollments."

·         Verify each enrollment record. 

CMS is diligently working to implement quality control measures to ensure accurate data is preserved in the future. However, it's best to be proactive. There are many changes coming to Medicare and its procedures. More paperwork and data entry is likely. Ensuring your information is accurate will protect your practice from problems down the road.