PECOS: CMS announces second delay

Thursday, February 18, 2010

BALTIMORE - CMS officials announced during an Open Door Forum last week that they won't start denying claims that list prescribing physicians not registered with PECOS until Jan. 3, 2011.

Originally, CMS had planned to start doing that Jan. 5, 2010, then April 5, 2010.

"This gives us a lot more breathing room," said Andrea Stark, a consultant with Columbia, S.C.-based MiraVista.

Providers, however, will continue to receive warning messages for claims listing unregistered physicians.

The announcement was music to the ears of providers. Stakeholders have been telling CMS officials that there are numerous problems with PECOS, including physicians unable to get through to customer service with questions, and physicians unable to get applications processed.

Another concern: Providers feel they're the only ones educating physicians about the requirement.

"We clearly do not believe that HMEs should shoulder the burden for enrolling clinicians in PECOS nor do we think our claims should be the only ones that aren't paid if the referral source isn't enrolled," said Walt Gorski, vice president of government relations for AAHomecare, which has been in regular contact with CMS about PECOS problems.

Providers have said that CMS needs to do its part to educate physicians. Stakeholders say the agency will.

"CMS has verbally committed to actively participating in motivating these doctors to get into the PECOS system," said Stark. "As the word gets out, and as the pressure starts coming from other directions instead of just the provider community, we'll see the list of unenrolled physicians whittled down."

The lengthy delay--eight months--gives everyone from CMS to HME providers to physician groups time to get physicians enrolled in PECOS. It also gives industry stakeholders an opportunity to work with CMS to improve the system.

"We will follow CMS's lead and will provide recommendations and advice," he said. "If things don't change, we will be faced with similar problems in December."