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Report: OIG assesses PECOS implementation

Healthcare Auditing Weekly, April 17, 2007

When the OIG assessed the early implementation of the Provider Enrollment, Chain and Ownership System (PECOS) related to the timely processing of Medicare provider enrollment applications and system access, it found that the majority of Part A applications contractors reported as exceeding timeframes as of July 31, 2005, had not actually exceeded timeframes.

The OIG credits the confusion to the misinterpretation of CMS guidance. For instance, 66% of the Part A applications reported as exceeding the 99% processing timeframe had not actually exceeded it.

The misclassification was due to the fact that contractors retained applications awaiting tie-in notices in pending inventory or failed to update the record status in the PECOS correctly.

Part B applications contractors reported as exceeding timeframes as of July 31, 2005, were primarily the result of one contractor's backlog and providers' failure to respond to requests for information. Lastly, half of all contractors reported experiencing difficulty accessing the PECOS and obtaining and recertifying user ID numbers.

At the end of the report, the OIG suggested that CMS conduct updated training for Part A contractor staff to ensure consistent understanding of application-processing policy. Also, CMS should address issues with system access and user IDs that could lead to future delays in application processing.

CMS indicated in its comments that the information in the report will assist in its ongoing management of the PECOS, but believes that the startup issues noted have been resolved.

View the OIG's full report here.

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