PECOS update: Providers bemoan earlier deadline

Thursday, June 3, 2010

YARMOUTH, Maine - HME providers aren't happy about meeting a July 6 deadline for physicians to enroll in the Provider Enrollment, Chain and Ownership System (PECOS)--six months earlier then they had originally planned.

"We were moving at the CMS pace of January 2011 and all of a sudden it came out that it was July," said Bill Korslin, CEO of Naperville, Ill.-based Centrad Healthcare. "We are going to have to accelerate and change some priorities around."

While the change seemed to come out of the blue, it's outlined in the Patient Protection and Affordable Care Act, which passed in March. CMS then published an interim final rule, IFC-6010, seeking public comment in the May 5 Federal Register. The agency will publish a final rule sometime after the comment period ends on July 6.

In the meantime, the interim rule is the law of the land, CMS officials say, although it "may be tweaked based on public input," said Peter Ashkenaz, deputy director of media affairs, in an e-mail to HME News.

For HME providers--who risk having their claims rejected if their referring or ordering physicians are not compliant with the July 6 deadline--the change means they must go back to physicians and tell them to get a move on.

"I've been giving them a deadline that's non-existent," said Glenn Steinke, owner of Airway Medical in Bishop. Calif. "My job shouldn't be to tell the physicians there's been a change in plans."

Theresa Estes, who works for both an HME and a small physician's practice, can attest that some physicians had put PECOS on the back burner because they thought the deadline was several months away.

"They were putting it off until November," said Estes, contract specialist in charge of Medicare for Dodge City, Kan.-based Pos-T-Vac. "It wasn't a priority."

With the July 6 deadline now just a month away, providers are worried that physicians won't have enough time to complete the process.

"You don't just enroll in PECOS," said Steinke. "It can take a couple of months is my understanding."

To boot: Some providers say they are still getting errors on claims for physicians who are supposedly enrolled.

"Their office manager tells me they are enrolled in PECOS and they've verified it," said Sharon Sobie, an administrator at Star Medical Equipment in Davenport, Iowa. "You can't argue with the doctor's office."

CMS officials have said providers must make sure they are using the physician's legal name and Type 1 NPI on claims. Officials also encourage providers to use the online NPI registry to verify enrollment. The downloadable file is updated regularly, but providers complain it isn't user-friendly.

"I wouldn't touch that," said Estes. "It's a big headache."

While CMS officials won't provide the number of physicians who still need to enroll in PECOS, it's shrinking, providers say.

"We are seeing the list get smaller, but we weren't going to actively start working it until September," said Korslin. "We're going to need to see where everybody is."