Docs’ Name Discrepancies in PECOS

BALTIMORE — CMS has given AAHomecare clarification on
discrepancies in physicians’ names in the Provider Enrollment,
Chain, and Ownership System (PECOS). According to CMS, “the claims
processing systems will check against the legal name on file with
PECOS, and claims submitted by a DMEPOS supplier should reflect the
name and NPI combination on the ordering and referring file. If a
physician or eligible non-physician practitioner believes that
PECOS does not contain his/her correct legal name, then the
[non-physician practitioner or physician] can submit an update
using the Medicare enrollment application or Internet-based
PECOS.”

The association got the response after alerting CMS to instances
where HME providers have found discrepancies between the
physicians’ names listed in PECOS and the NPI registry names listed
in the NPPES. Because of the difference in how the names appear in
both databases, some HME claims are receiving warning messages
indicating that the ordering physician does not have a PECOS
enrollment record even though the physician is listed in PECOS.

The association has also requested additional guidance on how
HME providers can comply with the ordering or referring physician
PECOS requirement before CMS implements edits to reject
claims. AAHomecare said it continues to be concerned “about the
potential for CMS to audit and recoup funds from providers who
submit claims for DMPEOS items ordered by physicians who are not
enrolled in PECOS.”