PECOS stands for Provider, Enrollment, Chain and Ownership System. There is a centralized database system called CMS that maintains the information of registered healthcare service centers, individual practitioners, clinicians, health insurance companies and so on. PECOS offers registration in this database and removes possibilities of ambiguities that may occur while processing the medical bills.
Top Common Problems with PECOS
Apart from smoothening the revenue cycle management by avoiding discrepancies or duplication, PECOS helps the healthcare service providers solve the following finance-related issues:
- Medical billing issues:
Medical billing services need to ascertain the truthfulness and uniqueness of all the medical bills that come to them for processing. The medical insurance providers need to do stringent checks to ensure that the claims are not denied on ambiguous grounds. Having said that they also need to affirm that the claim is in the correct proportion when compared to severity of disease or size of treatment expense.
Many people speculate that denying the claim is a preference of the medical insurance company. However, the truth is that the medical insurance providers’ work increases manifold when a single denial happens. The denial increases working hassles of various other departments.
Even when the claim settlement goes in favor of the claimant, the medical insurance providers have to track and monitor the claim settled. This helps avoid duplicate claims.
- Insurance cover credentialing:
Insurance premiums make sense to the policy buyer when the out-of-pocket expenses for taking medical treatment are reduced appreciably. Healthcare service providers can take help of PECOS certification details to ensure that the claims are settled on time. Delayed settlements may create more liability for the insurance company and question its credibility. PECOS updates allow the credentialing process to speed up. The credentialing specialist takes the records from PECOS in consideration and helps the insurance provider remain by the side of the medical treatment seeker in actual sense.
- Issues related to EHR:
EHR is Electronic Health Record. The difficulties related to using these records can make the healthcare revenue cycle quite frustrating to maintain. Instead of using the EHR, PECOS referring can make the revenue cycle easy to understand as well as follow.
PECOS makes it easy for the healthcare insurance providers to keep the two basic problems related to EHR at bay. These problems are patient dissatisfaction and more instances of law suits. The PECOS use allows insurance settlement experts to help clinics have a quicker resolution system in place.
Unlike EHR, PECOS-backed records make it easy for the insurance companies to migrate the data in a fast and error-free manner. Thus, the settlements help save a lot of money and time of the insurance companies and create better experiences for the people who are already under the distress of treatment expenses.
- Negotiate contract rates:
It is a well-known fact that all healthcare providers get into insurance providers at varying rates. The negotiation skills may help have healthcare centers the best deals, but the insurance providers need help of a verified record to find the eligibility of the business for that rate. Taking help of PECOS records allows parties to negotiate the contract rates in a transparent and justified manner.
Since PECOS can speed up submitting the process of claims, the healthcare providers can have more claims done. By considering the volume of business provided to the insurance company, the parties can negotiate the rate when the contract comes for renewal in the ensuing term.
Revenue cycle consulting becomes bias-free with the help of PECOS records. Since there is a common observation that insurance providers do not behave responsibly or politely with the individual medical practitioners, PECOS registration can help such practitioners to change the attitude of these entities.
These are the four very crucial problems that medical services face when they deal in settlement of medical bills. Insurance is bought with the hope of having a financial cushion in the instances of medical emergencies. The faster resolution of claims issues makes this cushion meaningful and allows the people in distress to have financial support for the treatment without depending on others or taking obligation from other people.
PECOS makes the whole process of getting help for the treatments faster, easier and dispute-free. The system safeguards the interests of the insurance companies, too, by saving them from financial loss of any kind.