If you’re a participating Medicare provider, there’s an excellent chance that some of your enrollment information stored with CMS is not accurate, according to
an OIG report released May 28.
About 58% of provider records in the Provider Enrollment, Chain and Ownership System (PECOS) – the electronic database used by CMS to store enrollment data – are not accurate, the OIG found. Another 4% of PECOS records were incomplete, and physical addresses are the least accurate item, which compounds the problem because it’s tough to ask questions when you can’t reach the provider, the OIG noted.
Also, there is a staggering mismatch rate of 97% between provider information in PECOS and corresponding information housed in the National Plan and Provider Enumeration System (NPPES), which is the database containing the all-important provider NPI numbers used to bill Medicare.
For legitimate providers, these findings help explain why claims can suddenly start being denied, frozen or otherwise disrupted whenever CMS discovers an inaccuracy. The data inaccuracies also can result in innocent providers being audited and suspected of fraud, especially when the wrong address leads to waves of action letters not being received.
The high percentage of inaccuracies and inconsistencies show that problems persist, despite vigorous efforts by CMS to clean house via an ongoing nationwide revalidation of all provider data. This effort, mandated by the Affordable Care Act, will continue into 2015.