LUTZ BUSINESS INSIGHTS
provider-based departments update 2019
The Centers for Medicare and Medicaid (CMS) Are Requiring Hospital Provider-Based Departments (PBDs) to be Properly Enrolled in Provider Enrollment, Chain, and Ownership System (PECOS)
Expected to begin in July 2019, Hospitals need to ensure all off campus provider-based departments (PBDs) are separately listed in the Provider Enrollment, Chain, and Ownership System (PECOS). PECOS supports the Medicare Provider and Supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information. Hospitals should also ensure their claims accurately identify the location where the services are rendered; this should match the exact PECOS enrolled location. This edit applies to hospital bill type 13X and 14X.
Hospitals may use this opportunity to not only update the information for provider-based departments, but also update the information in PECOS for the following scenarios:
- Initial Enrollments
- Changes of Information
- Staff Departure
Hospitals should work quickly to submit the enrollment application as some Medicare Administrative Contractors (MAC) can take weeks to approve changes and enter these into PECOS. Hospital billing staff must confirm that the location where services are rendered on the claim matches what is submitted to be updated in PECOS.
*Refer to CMS Change Requests 9613 and 9907 for additional information.
Activation of Systemic Validation Edits for OPPS Providers with Multiple Service Locations. March 26, 2019. MLN Matters. Retrieved on June 20, 2019 from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE19007.pdf
Medicare Enrollment for Providers and Suppliers. N.D. Retrieved on June 20, 2019 from https://pecos.cms.hhs.gov/pecos/login.do#headingLv1
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