Open door forum

Sunday, October 25, 2009

BALTIMORE - HME providers say the burden of educating physicians about a new Medicare rule that goes into effect next year has fallen largely on their shoulders, and they're not happy about it.

The rule, which goes into effect Jan. 4, 2010, requires providers to include the legal names and NPI numbers of ordering or referring physicians on their claims. It also requires physicians to be listed in Medicare's Provider Enrollment Chain and Ownership System (PECOS).

The problem, according to providers: There are physicians who don't have a clue what PECOS is.

"We've had several of our members contact physician offices and they're unaware of the program," said Rose Schafhauser, executive director of the Midwest Association for Medical Equipment Services (MAMES), during yesterday's Open Door Forum. "(Physicians) are asking us to help them register."

Providers can check to see if physicians are listed in the system at The rule also applies to non-physician practitioners, including physician assistants, certified nurse specialists and nurse practitioners.

The rule puts providers between a rock and a hard place: After it goes into effect, Medicare will begin rejecting claims that include the names and NPI numbers of unlisted physicians. In October, the agency began sending providers "informational messages" to alert them of such claims.

"I'm getting feedback from many of our members that the majority of their claims are getting (informational messages)," said Bruce Rodman, vice president of health information and policy for the National Home Infusion Association. "They're very, very concerned."

Medicare officials maintain that they've been educating physicians about the rule for several years, including during a recent Open Door Forum for physicians, and that they will continue those efforts. But providers are less than impressed.

"We're already trying to keep our heads above water, and now we've been handed the daunting task of trying to get our physicians to do what they need to do when there's no incentive in it for them," said one provider.

While several providers called for delaying the rule, Medicare officials made it clear that's probably not in the cards.

"We will continue to evaluate (the situation)," said Medicare's Jim Bossenmeyer. "But there is currently not a decision made to delay this process, and I would not count on one happening."