Open Door Forum on PECOS: CMS officials stick to script

Thursday, May 20, 2010

BALTIMORE - Callers to last week's Special Open Door Forum had to listen between the lines when it came to certain Provider Enrollment, Chain and Ownership System (PECOS) updates.

CMS on May 5 published an interim final rule that would speed up the deadline for physicians and other eligible practitioners to become compliant with PECOS by almost six months to July 6, 2010.

"The statute requires that a physician or eligible practitioner must be enrolled to order and refer in the Medicare program," said Medicare's Jim Bossenmeyer. "You can submit comments in response to that regulation."

What wasn't clear during the call was whether that meant that Medicare would begin denying DME claims in July, instead of Jan. 3, 2011.

"(Bossenmeyer) would not confirm 'yes' or 'no' that we would begin receiving denials," Rose Schafhauser, operations administrator for the National Supplier Clearinghouse Advisory Committee (NSCAC), told HME News after the call. "He was very careful--he just kept referring to the rules."

Technically, the Jan. 3, 2011, deadline is still valid, but with the regulation effective July 6, providers are understandably worried, said Schafhauser.

Meanwhile, if it's any consolation, HME providers aren't the only ones who are afraid of getting referrals from non-compliant physicians. A caller from a radiology center asked: "In layman's terms, if we have a doctor that refers to us that's not enrolled in Medicare--"

"--You will not be paid," Bossenmeyer responded.

One piece of good news during the call: Internet-based PECOS will be available for DMEPOS providers starting July 13.

"We believe Internet-based PECOS will be significantly faster, and result in less errors and less requests for development from the contractors," said Bossenmeyer.

Internet-based PECOS is a huge step forward, confirmed Schafhauser. Nearly 85% of paper applications from DMEPOS providers require additional information, she said. The online application process, as she understands it, will not allow the user to move onto the next page until the current one is completed.

Even better, Schafhauser said, providers will be able to check their files to ensure the NSC has the correct information.