CMS to providers: No PECOS grace period

Thursday, May 27, 2010

BALTIMORE - CMS officials aren't cutting HME providers any slack when it comes to complying with the July 6 deadline for the Provider Enrollment, Chain and Ownership System (PECOS).

HME providers who take Medicare referrals on or after July 6 from physicians not enrolled in PECOS risk having those claims rejected, CMS officials stated during last week's Open Door Forum.

Some providers believed they had until Jan. 3, 2011, before those claims would be denied, but that is not the case, said CMS's Jim Bossenmeyer.

CMS is right now implementing system edits to detect if an ordering and referring physician is enrolled in PECOS. The edits may not be in place by the July 6 deadline, but CMS "reserves the right to go back and reprocess claims," Bossenmeyer said.

"When we implement edits, if we do not have the correct name and NPI combination on the claim for the ordering and referring (physician) or the person is not enrolled in the Medicare program, your claim will be rejected," he said.

CMS will give providers advance notice of when the edits will be in place, he said.

On May 5, CMS published an interim final rule requiring physicians and other eligible practitioners to become compliant with PECOS by July 6, nearly six months earlier than the previous Jan. 3, 2011, deadline.

"We encourage individuals and organizations who have comments on the interim final regulation to submit those comments as soon as possible," Bossenmeyer said. "We will carefully review comments and concerns that you have raised about complying with the July 6 deadline. The interim rule, however, is effective until we publish a final version."

To determine if a physician is enrolled in PECOS, Bossenmeyer directed providers to CMS's Medicare Provider-Supplier Enrollment Web page at To get a list of eligible physicians, click on the Ordering Referring Report on the left-hand side of the page and scroll down to the downloadable file.