Palmetto GBA recently introduced Online Provider Services (OPS), a free Internet-based, provider self-service portal. The OPS application provides information access over the Web for the following online services:

One particularly useful feature of the new web site is the ability view a complete historical listing of Medicare Payments and EOMBs for a specified date range.  Payment details can be displayed online and also printed individually for your convenience.  Another valuable benefit is the ability to check on the most recent payments issued by Medicare.

 

You can participate in OPS if you have a signed electronic data interchange (EDI) Enrollment Agreement on file with Palmetto GBA. If you are currently submitting claims electronically to Medicare as most PDS clients are, this requirement should have already been met.
 

If you would like PDS to register your practice for access to OPS, please contact Dee at (619) 757-2200 ext. 142 for assistance.  In most cases we can complete the process for you in just a few minutes.

By now most practices have probably heard about PECOS registration, but what is PECOS and why is registration mandatory?
 
PECOS stands for Provider Enrollment, Chain, and Ownership System and it's the database Medicare began using in 2005 to manage provider data.  Five years later, many providers are still not enrolled in PECOS even though they are active Medicare providers.  Enrollment in PECOS is not automatic.  If you haven't made any changes to your practice information or revalidated your information with Medicare since 2005, you may not be included in PECOS.
 
Currently the deadline to register in the PECOS system is January 3, 2011, however CMS is considering moving that date up to July 6, 2010.  The issue is still being considered and, according to Medicare, no official decision has been made yet.  In either case, now is the time to begin the process of enrolling in the PECOS system.  PECOS registration can be completed online or with a paper application.
 
There are many time saving advantages to PECOS.  Once registered, the following tasks can be handled online:

It's important to note that after the registration deadline, Medicare claims that indicate rendering or referring physicians who are not enrolled in PECOS will be denied.  It's also important to mention that groups as well as individual providers must be registered in PECOS.
 
Learn more about PECOS registration at the following links:

 

 

 

To determine your PECOS registration status go to:

 

 

Or contact Palmetto GBA Medicare provider enrollment at (866) 895-1520.

 

The Medicare Fee Schedule contains two different reimbursement amounts for certain procedures when they can be performed in either a facility (hospital) or non-facility (office) setting.  The difference between the two amounts is known as the "site-of-service differential".  The reimbursement rate for physician services performed in a facility is usually quite a bit lower since it assumes that the overhead expenses (supplies, equipment, etc.) are not being paid for by the physician.

 

When a new fee schedule is created and imported into our billing program, we default to the higher of the two charge amounts whenever we are uncertain of the location where a service is rendered.  This insures that we don't inadvertently undercharge for the procedure and "leave money on the table".

 

If you notice this type of situation when reviewing your EOBs and know that the procedure is always performed in a hospital setting, call us or send us an email with the particular CPT code(s) and we'll update your billed charges to reflect the appropriate amount based on the site of service.