Providers should be ready to go Jan. 3

Tuesday, November 23, 2010

BALTIMORE - HME providers next month may start seeing claims denied if they contain the names of physicians who aren't enrolled in PECOS.

"CMS hasn't issued any instructions to change the date for rejection of claims," said Andrea Stark, a consultant with Columbia, S.C.-based MiraVista. "It's progressing as far as we know--subject to change at the last minute."

As it stands, claims that aren't compliant with PECOS could get denied starting Jan. 4, 2011,

AAHomecare, along with a coalition of physician and pharmacy groups, is pressing CMS to push back the deadline to match the July 5, 2011, deadline for home health agencies (see story  previous page).

"We don't believe that CMS should have different deadlines for different types of providers," said Walt Gorski, vice president of government affairs for AAHomecare. "How do you encourage people to enroll if you have these shifting deadlines?"

In the meantime, providers are still scrambling to ensure physcians are enrolled.

Becky Wenrich, DME/Medicare consultant at Longenecker Pharmacy in Parkesburg, Pa., regularly checks the PECOS pending report and ordering and referring report to check whether her referral sources are enrolled. It can be time consuming, she said.

"Several times, a physician will appear on the pending report, but then they drop off the ordering and referring report," she said. "I'll have to call them again to tell them."

That's exactly what she should do, said Stark. What's probably happening, she said, is applications are getting dismissed because physicians aren't responding in time when they get a request for further information.

"If you see a physician fall off, then that physician needs to be contacted and told to get back in touch with the contractor that's processing the application," she said.