Medicare tries to push doctor enrollment online

Washington -- Federal officials are attempting to make a new online Medicare enrollment system more accommodating to physician practices after initial access restrictions led to a lackluster debut for the highly promoted initiative.

The Centers for Medicare & Medicaid Services said the new Internet-based Provider Enrollment, Chain and Ownership System, or PECOS, will speed up the application process, provide more accuracy and security, and reduce paperwork for physicians who are signing up for Medicare for the first time or changing their enrollment information. The agency advertised that the process would be an attractive alternative to paper enrollment form CMS-855. But since the system was opened to doctors in December 2008, it has been largely shunned by practices, many of whom were discouraged by the requirement that only physicians and nonphysician practitioners -- and not their billing staffs -- could access PECOS.

In response to the criticism, the agency will change the policy within weeks to allow physicians' credentialing staff to use PECOS, said Kim Brandt, director of program integrity for CMS' Office of Financial Management. The language presented to physicians entering the enrollment process will be changed, Brandt said, from "Do not share your user ID or password with anyone" to something like "Be careful who you share your user ID and password with, if you choose to give that information to a third party."

Brandt warns, however, that physicians run the risk of security breaches and identity theft if they allow third parties access to the information.

"If a doctor chooses to give that information to a third-party billing agency or others, it's not that they will be kicked out of Medicare or anything. But they need to be aware that if any changes happen to their record or if there is any inappropriate sharing of their information, it's their responsibility to make sure their information is correct and that no one is using the information" in the wrong way, Brandt said.

Professionals who do Medicare billing and enrollment work were relieved to hear that staffers will be able use PECOS on behalf of physicians.

"Credentialing departments will find this a major break, because the bottom line is that the physician does not do his or her own administrative work for credentialing," said Barbara Cobuzzi, president of CRN Healthcare Solutions, a New-Jersey-based consulting group.

"They leave it to their administrative staff, who are not only the staff the physicians wish to delegate this task to, but the staff best qualified to perform this task accurately," she said.

Since the launch of the new initiative, few physicians have logged on to PECOS. For the period from Dec. 4, 2008, to Jan. 8, 2009, CMS reported that 124 different physicians and NPPs logged onto PECOS and that 295 transactions were submitted.

Practices cited the access restrictions as one of the main reasons for avoiding PECOS. In a conference call Jan. 13, CMS fielded several inquiries about the physician-only requirement. CMS did not realize that most doctors rely on billing staff to handle these processes, participants said.

"It's absurd for CMS to qualify an online enrollment performed by a staff member or business associate as being a misrepresentation when the information is the same as what it is on paper," said Cyndee Weston, executive director of the American Billing Assn.

Larrie Dawkins, practice administrator and chief compliance officer for Wake Forest University Health Sciences in Winston-Salem, N.C., said his staff of three would need to train 800 physicians if Wake Forest decided to use PECOS the way CMS launched it. He initially broached the topic with just one physician, who called the Internet tool a waste of time.

"We want physicians to see patients," Dawkins said. "This is not something they would normally do but once or twice in their lives."

PECOS advantages and challenges

Brandt said CMS took the feedback from the conference call and other sources to heart. As a result, the agency decided to make the change to "strike a better balance that will address not only our security concerns, but also the practical realities of the physician practice."

CMS has promoted PECOS for months as a better method of enrolling in Medicare, as well as updating and tracking enrollment data changes.

Officials said users could see benefits in several ways, including: the assurance that all required questions are answered and data entered before the transaction is submitted; the ability to print a completed application or update before submittal; the option to print a list of required paper documentation to be mailed to Medicare contractors; and the ability to check the status of applications and updates online. Processing times should be quicker than with paper transactions.

CMS expects to have a second phase of PECOS operational later this year, which will provide the same online capability to institutional Medicare participants and others.

CMS has acknowledged some PECOS limitations. Paper forms must be used if doctors want to change a legal name or Social Security number, change their business structure, or reassign payments to someone not in the system.

In addition, PECOS is not available to suppliers of durable medical equipment, prosthetics or orthotics. CMS said it hopes to accommodate some of the "unique enrollment requirements" for these suppliers by early 2010.