Performance Improvement 2008. Did the New Medicare Provider Enrollment Data System Fail to Improve Application Processing of, and System Access for, Providers?


Researchers from the Office of Inspector General assessed early program timeliness of Medicare provider enrollment application processing and system access in the Provider Enrollment, Chain and Ownership System (PECOS). PECOS is the primary location of enrollment records for Medicare providers, such as physicians, hospitals, and laboratories. It serves as the frontline defense preventing fraudulent providers from participating in Medicare and was expected to greatly reduce the time needed to process provider enrollment applications. Researchers collected records from contractors of all provider enrollment applications exceeding established timeframes for July 2005. Researchers aggregated this data, selected stratified random samples of applications, and contacted the contractor that owned each application to determine the reason it was delayed. Researchers conducted structured interviews with all contractors regarding their experiences with PECOS, factors that commonly delayed processing of applications, PECOS training and guidance received, their understanding of application processing procedures, and their oversight by the Centers for Medicare and Medicaid Services (CMS). Researchers also conducted structured interviews with provider enrollment and PECOS access staff in each CMS regional and central offices.

Early implementation of the new system had mixed results. Over half of all contractors reported difficulty accessing PECOS. Due to a misinterpretation of agency guidance, the majority of Part A applications´ contractors reported exceeding timeframes as of July, 2005, had not exceeded timeframes. Part B applications contractors reported as exceeding timeframes, were primarily the result of one contractor's backlog and providers' failure to respond to requests for information.

Report Title: Provider Enrollment, Chain and Ownership System: Early Implementation Challenges.
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact:
Claire Barnard, 202-205-9523
Performer: Office of Inspector General
PIC ID: 8785

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