Beginning on January 6, 2014, Medicare began enforcing the rule that states that, claims for diagnostic services, such as radiologic studies or pathologic analysis, will not be paid if the test ordered or specimen submitted is submitted by a practitioner who is not “registered” with Medicare’s enrollment system, the Provider Enrollment, Chain of Ownership System (PECOS). PECOS enrollment is separate and different from having an NPI number or being a current Medicare participant. This rule applies for the submission of specimens to ANY laboratory and referrals to ANY diagnostic radiology center in the USA.
Medicare has made it clear that this rule applies to dentists and dental specialists and has begun denying claims that have been filed with surgeons who are not registered PECOS providers. In order to make sure that all diagnostic services (pathologic and radiologic) for patients 65 years and older are paid for by Medicare, all dentists and dental specialists MUST register with PECOS as soon as possible. Even if, as a dentist, all or most of your services are not covered by Medicare, you still need to register with PECOS so that any diagnostic services you may in the future order or perform for patients 65 years old or older will be covered. Lack of enrollment may affect coverage for prescriptions that you might write for Medicare patients. This registration DOES NOT require you to become a Medicare participant.
How to register to be a provider who solely orders and certifies
For your convenience, included here is the link and ways that you can register in PECOS to be eligible to refer for part B services. Registration for PECOS, which is free, can be done is several ways and depends on your enrollment status in Medicare. You can:
Learn more about registering for Medicare and/or becoming eligible to refer for Part B services (found under tab labeled “Providers Who Solely Order or Certify”):
Use this link to learn more about registering for Medicare and/or becoming eligible to refer for Part B services (found under tab labeled “Providers Who Solely Order or Certify”):
MLN9658742 – Medicare Provider Enrollment (cms.gov)
Regardless of whether or not you are a registered PECOS provider or Medicare provider, all Medicare patients and Medicare age patients (65 and older) must fill out an Advance Beneficiary Notice of Noncoverage (ABN) form.
Instructions on completing the ABN Form >>