CMS continues to frustrate providers on PECOS

Thursday, July 8, 2010

BALTIMORE - A day after the July 6 deadline for physicians to register with PECOS, CMS officials still couldn't reassure the HME industry that non-compliant claims wouldn't be subject to future recoupment efforts.

CMS has delayed its automatic claim rejections to give physicians more time to comply with an interim final rule, published May 5, that sped up the PECOS deadline by six months, but providers are wary of future audits.

During a July 7 Open Door Forum, Walt Gorski, AAHomecare's vice president of government affairs, asked:

"Can you address (this) specific issue: CMS and its contractors will not seek recoupment from claims that are receiving warnings during this period?"

CMS's Jim Bossenmeyer said providers should focus on these steps to ensure claims are, otherwise, compliant: They should submit claims with the physician's legal name and Type 1 NPI number; they should have written documentation that the service has been referred to them; and they should ensure that the referral source has a valid license and has not been excluded by the Office of Inspector General.

Gorski countered: "So if we do that and a ZPIC or RAC audit occurs in 2012 and they look and see that the referring physician was not enrolled in PECOS--you are telling the supplier community that the money will not be recouped?"

Bossenmeyer: "I have not said that. I understand what you would like me to say, but I cannot give you that answer today."

The public comment period for the IFR closed July 6 and CMS said it would review comments before issuing a final rule.

Meanwhile, the agency continues to update and make improvements to PECOS. Last week, it also added nearly 30,000 "pending" applications--about 26,000 from physicians--to the site.

"We will process applications as expeditiously as possible," said Bossenmeyer.

Bossenmeyer also announced during the call that Internet-based PECOS for DMEPOS providers, which had been scheduled to go live July 13, has been delayed until the fall.