CMS still wishy-washy on start date for PECOS denials

Wednesday, October 13, 2010

BALTIMORE – The newest question surrounding CMS’s PECOS requirement: Has the agency delayed the date when it will start denying non-compliant claims from January 2011 to July 2011?

During an Open Door Forum on Oct. 14, CMS officials and listeners debated the meaning of a recent change request that states the agency won’t pay home health agency claims that contain the names of physicians not enrolled in PECOS starting July 5, 2011, instead of Jan. 4, 2011.

When asked during the forum to confirm that the new target date for denying non-compliant claims is July 5, 2011, John Spiegel, the director of the Medicare Program Integrity Group, didn’t exactly give a straight answer.

“These dates are targets that we’re looking at,” he said. “Nothing is established in final yet.”

To read CR 6856, dated Oct. 8, go to

When asked whether the July 5 date also applies to HME claims, Spiegel again sidestepped the question.

“It’s not likely that (the denials) would be before July,” he said. “I did not say that it will not be before July. I don’t think it will be before July, but you can never tell.”

The one thing Spiegel was clear about: CMS realizes that there have been a number of problems with PECOS, notably a backlog in the number of physicians trying to enroll in the system, and it will not start denying claims until those issues have been reasonably resolved.

“The criterion for when it is, is when the files are right,” he said.