Safety First: Managing Enrollments Properly through PECOS

When it comes to sharing personal information, the rule of thumb is to keep the information, well, personal. Ask your company’s IT manager for their thoughts about making a private password public and you’ll probably receive a worried look in response. But sharing accounts or logins can work in certain situations, like spouses that both have access to a joint checking account, or perhaps friends that share the password to their favorite streaming provider.

One industry where sharing personal information is frowned upon is healthcare. Not only does the Health Insurance Portability and Accountability Act (HIPAA) ensure patient medical information stays private, but security guidelines, password requirements and consent forms addressing the transmission of patient-practice communications across various mediums are incorporated by medical practices, hospitals and health systems of all sizes. In today’s age where phishing, hacking and other security threats are becoming more commonplace, it’s more important than ever to utilize proper security-related protocols in all aspects of business.

The Centers for Medicare & Medicaid Services (CMS) administers government-sponsored Medicare to Americans 65 years of age and older. Its Provider Enrollment, Chain, and Ownership System – commonly known as PECOS – is the go-to online enrollment management system. PECOS allows registered users to:

• Enroll as a Medicare provider or supplier
• Revalidate enrollment
• Withdraw from the Medicare program
• Review and update information
• Report changes to your enrollment record
• Electronically sign and submit enrollment information

Every user of the PECOS portal should have their own assigned account. TriZetto Provider Solutions manages client enrollments within the system, properly and securely. Our experts utilize their own login information, and our users have also completed two-part authentication, which requires phone or email verification to keep the account as secure as possible.

Just as HIPAA is critical to protecting the privacy and security of health information, using proper credentials and security best practices also is a necessity. When it comes to adhering to security best practices, unfortunately, not every company is following protocol.  But here at TPS, we like to think of ourselves as being ahead of the curve.

As of late, compliance is a common topic of discussion. Is your front office staff using a provider’s login? In an ideal world, every user should have their own assigned login to a PECOS account. This ensures complete compliance. However, that’s easier said than done.

Some practices may not be aware that they are not in compliance. Is your practice – or the third party service vendor your practice has contracted – following the guidelines? Hopefully so, because the last thing a practice wants to deal with is an audit. If your practice faces an audit, hours of time will be required and stress will quickly accumulate. Not to mention, the possible financial consequences can be dire. While that may be the worst case scenario, it’s definitely a possibility that needs to be taken into account. The rules are being enforced, and you don’t want to be out of compliance with one of the top payers in the country. In this situation, TPS is considered a delegated authority. Our experts have been granted surrogacy, which gives us access. It’s the secure way to do it.

Perhaps your practice, or the assigned team member, is new to the system. PECOS has a tendency to become confusing quickly, especially to those unfamiliar with the program. Thankfully, our in-house experts are available to help navigate the complexities. We often come across clients that may not have used PECOS in the past, and we can guide them along. Training sessions, step-by-step guides, or just an expert on hand to bounce questions off of, can be extremely valuable when completing applications. With expert users on site with decades of experience under their belts (including former Medicare staff members), we really know the ins and outs of the system.

Additionally, Medicare has moved away from paper applications, as have many payers. The digital way is quicker, but perhaps you have users on staff that are not very technically savvy. News was recently released that PECOS 2.0 is set to debut in July of 2023. Do you feel confident you can navigate the upcoming changes?