‘Mega’ Enrollment Form on PECOS 2.0 Should Reduce Burden; Providers Will Have One Profile

When CMS unlocks PECOS 2.0, providers and suppliers are expected to get some relief from the heavy lift of Medicare enrollment and revalidation. CMS is rolling out a consolidated billing form for PECOS—the Provider Enrollment, Chain and Ownership System—with a national profile as the nucleus.

Providers and suppliers will have to wait a little bit longer for it. “PECOS 2.0 will be available to providers and suppliers in 2024,” a CMS spokesperson tells RMC. But experts expect it to be worth the wait.

“If it rolls out as they claim and works as they say it’s going to, you will be able to do one mega enrollment form,” said attorney Judy Waltz, with Foley & Lardner LLP in San Francisco. That would spare a health system or nursing home chain, for example, from updating dozens or hundreds of forms when all their locations are affected by a change (e.g., a new corporate executive, change in controlling individuals, relocated corporate headquarters). “It looks like a significant step toward making enrollment much more tolerable in terms of the administrative burden,” she said.

According to an August update to Chapter 10 of the Medicare Program Integrity Manual, “In PECOS 2.0, individuals and organizations will have National Entity Profiles. [...] A party’s National Profile will show Medicare enrollment record(s) for each of their provider/supplier types (e.g., ABC, Inc. will have one National Profile that includes 3 separate Medicare enrollment records: one for its clinic/group, one for its durable medical equipment (DME) enrollment, and one for its IDTF enrollment). All such records will be grouped by provider/supplier type due to differences in data collection and/or processing requirements.”[1] A provider/supplier will be able to submit one consolidated application for each provider type, which will be sent to the Medicare administrative contractor (MAC) for the jurisdiction. “The profile is like an umbrella,” Waltz said.

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