PECOS: CMS says claims will be paid, but worries remain

Thursday, July 1, 2010

BALTIMORE - CMS announced last week that it would not begin denying claims that are not compliant with the Provider Enrollment, Chain and Ownership System (PECOS) by the July 6 deadline.

"We're not going to implement changes that would automatically reject claims," said Peter Ashkenaz, deputy director of media affairs for CMS.

The July 6 deadline is nearly six months earlier than a previous Jan. 3, 2011, deadline.

The change was included in the Patient Protection and Affordable Care Act, which passed in March, and on May 5, CMS published an interim final rule that included the new deadline. That left providers scrambling to try and get referral sources enrolled--a process that can take two to three months.

"We understand that there were problems that some providers have experienced with PECOS," said Ashkenaz. "These are people that have made good faith efforts."

CMS's announcement was small comfort to industry stakeholders, who say that providers could still be vulnerable to post-payment audits.

"The question still remains whether those claims will stay paid once the auditors begin to look at them," said John Shirvinsky, executive director of the Pennsylvania Association of Medical Equipment Suppliers (PAMS). "How much risk can we take?"

Based on last week's announcement, it appears that CMS doesn't plan to seek repayments on non-compliant claims, but industry stakeholders want something more concrete.

"CMS needs to make a definitive statement on this," said Walt Gorski, vice president of government affairs for AAHomecare. "This is a bigger issue than HME. This is pharmacies, home health agencies and physicians. This is everybody."

For providers, that could be a good thing, if the old adage that there is strength in numbers holds true. Rep. Eddie Bernice Johnson, D-Texas, began circulating a "Dear Colleague" letter last week, urging CMS to delay the PECOS compliance date. The deadline to sign onto the letter is July 6, the same date comments close on the rule.

"There's been a lot of interest in this," said Ashkenaz. "There can be a lot of changes to the final regulation."