Physician credentialing helps healthcare institutions assess medical providers’ qualifications and expertise to enhance patient safety and quality of care. Institutions can leverage PECOS to make the credentialing process more manageable. Here’s an in-depth look at PECOS and how it’s used in credentialing.
The Provider, Enrollment, Chain, and Ownership System (PECOS) is an online management system that facilitates Medicare enrollment. The Centers for Medicare & Medicaid Services (CMS) introduced PECOS as an alternative to Medicare paper applications, allowing healthcare providers to enroll in Medicare faster.
The system also accepts enrollment renewals, information updating, and withdrawals from the Medicare program. Healthcare providers required to register on PECOS include nurse practitioners, clinical social workers, physicians, physician assistants, and registered nurses. This makes it a hub of information for healthcare organizations conducting credentialing.
PECOS and Credentialing
PECOS can be a valuable resource for a physician credentialing team as it contains physicians’ personal and professional information. You can find physicians on the database using their National Provider Identifiers (NPIs). These are unique identification numbers issued to healthcare providers to help them relay medical information faster electronically.
Ask physicians to provide their NPIs during application if you intend to use PECOS for credentialing. This eliminates the need to search through the NPI registry, making work easier for your credentialing team.
How to Use PECOS in Credentialing
Here are ways you can leverage PECOS in credentialing:
Confirm a Physician’s Identity and Qualifications
PECOS requires physicians to provide personal identifying information like their legal name, date of birth, and social security number. You can check the details on the database against those provided by a physician in their application to determine their accuracy.
The database also requires physicians to provide their schooling, certification, and specialty information. The information provided includes the name of the school studied at, graduation year, certification number, state where issued, and the date issued. Your credentialing team can use this information to determine whether the physician being credentialed can practice in their chosen field. Using PECOS eliminates the need for contacting every educational institution or certification body mentioned by a physician in their application.
Assess a Physician’s Licensure in Real-Time
PECOS contains information on physicians’ licensure, including their medical license number, state where issued, and the original and expected renewal dates. The system allows physicians to update their licensure information whenever necessary, so you can rest assured you’ll get up-to-date information. You can use the database to confirm if a physician’s license is up-to-date and if they can practice in your area.
Check a Physician’s DEA Status
Medical providers need a Drug Enforcement Administration (DEA) certificate to prescribe and dispense controlled substances. Prescribing drugs without this certificate is illegal. PECOS requires physicians to provide their DEA number while enrolling for Medicare. You can minimize your legal liability by checking a physician’s DEA status before hiring them.
Assess a Physician’s History
PECOS can make it easy for healthcare organizations to get information on a physician’s history. The database requires applicants to disclose suspensions or revocations of licenses or certifications by state licensing bodies or accreditation organizations. Licensure revocation or suspension can indicate fraud or physician incompetence.
Physicians are also required to disclose convictions for federal or state felony offenses. This makes PECOS a convenient investigation platform. You can use the database to assess whether a physician will jeopardize patient safety.
Assess a Physician’s Medicare Enrollment Status
Professionals like clinical social workers, physician assistants, osteopathy doctors, and optometry doctors reserve the right to opt out of Medicare. If they do, they’re not eligible for reimbursement from Medicare. This means their patients must pay for services out-of-pocket.
Your credentialing process should involve checking a physician’s enrolment status if your organization caters to Medicare patients. PECOS can tell you if a physician’s enrollment is current and active.
PECOS Reliability as a Source of Information
PECOS is a reliable source of information as it verifies the information physicians provide before approving their enrollment. The system cross-references the information with other sources like state licensing boards and the National Plan and Provider Enumeration System (NPPES). It does so to make sure physicians are qualified to participate in Medicare.
PECOS Can Help With Physician Credentialing
Physician credentialing is a critical step in medical organizations’ hiring processes. It involves evaluating and authenticating physicians’ qualifications, clinical competence, and malpractice histories to determine if they can offer reliable and safe patient care. PECOS can facilitate efficient credentialing by giving healthcare organizations access to physicians’ information on one platform.