Accreditation: Align codes in PECOS 

Q. What steps can my company take to safeguard reimbursement for products sold or rented to Medicare patients?  

A. You may be receiving payment from a variety of sources including Medicare Part B and private payers. Your accreditation organization (AO) has a role to play because CMS requires that AOs verify the products you are supplying to patients and that you meet the requirements to supply those products. This may include the use of credentialed personnel, state licensure or other requirements.  

You can streamline the payment process and avoid unnecessary lapses by aligning product codes in PECOS and those reported to your AO. Inconsistency is a common error that can result in denial of payment. Products provided by home medical equipment suppliers are broken into different product codes that often cover similar types of products. HME suppliers report these product codes on their 855S in PECOS and to their AO. The AO then reports on its verification to CMS. 

Because Medicare reimbursement is tied directly to the product codes reported via PECOS and those reported to your AO, it is important that you carefully match any new products you are planning to bill to the appropriate product code. A HCPCS-to-Product-Code Crosswalk tool was created to help suppliers identify the HCPCS included within each product code. Use this crosswalk tool to determine which product code captures the new HCPCS being billed. The crosswalk is updated quarterly, so it is important to use the most current version.  

AO-reported codes must match PECOS exactly, but your AO does not have access to your information in PECOS. That means suppliers must also remember to take three actions:  

• Use the current crosswalk to identify product codes.  
• Report their updated codes to their AO.  
• Update their 855S in PECOS when new products are added.  

Tim Safley is program director for DMEPOS and Sleep Accreditation with Accreditation Commission for Health Care, Inc. (ACHC).