CMS's behavior on PECOS has been disgraceful

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06/03/2010

When it comes to PECOS, the bureaucrats at CMS ought to be ashamed of themselves, especially Jim Bossenmeyer.

At last week's open door forum, two different listeners asked Bossenmeyer if home medical equipment providers had until Jan. 3, 2011 to begin submitting PECOS compliant claims. Most providers believed that to be the case, but on May 5, CMS published an interim final rule requiring physicians to become compliant with PECOS by almost six months to July 6, 2010. The rule created confusion.

Here's how Bossenmeyer answered the first question on this issue: The ordering referring report that we have on the Web site contains information, and we'll update it again probably in the middle of June. As physicians are enrolled, that information is updated in our system and shared nightly with our claims processing systems. So initially while the compliance date is July 6, you are correct that is the date that the DMEPOS suppler or home health agency is required to put the name and NPI of their individual who has ordered or referred the service. When we establish and implement the editing of process those claims will be rejected on the front end of the process. They will not be denied.

Huh? It sounded like Bossenmeyer had answered a different question. I was confused. So was the person who asked the question, which is why he asked the same question again to which Bossenmeyer issued a bureaucratic response as twisted and confusing as his first. Later on, a second listener asked for more clarification on the PECOS implementation date. Bossenmeyer again responded in regulatory gibberish.

He recited the same gooblygook when HME News called him this week, looking to clarity. Fortunately, we were able to whittle that interview down into a coherent article.

Maybe I'm just too literal. When someone asks a yes-or-no question, I expect a yes-or-no answer. By getting all technical, CMS is just adding confusion to an already confusing topic. When providers ask CMS for help, I expect CMS to help. To do otherwise is unacceptable and dereliction of duty.

Of course, after all the back and forth with CMS, we do have them on the record saying: "The interim final rule is effective until we publish a final version of the rule." I read that to mean (and I'm not the only one) that providers better make sure their claims are PECOS compliant on and after July 6—or until CMS tells you otherwise.

Mike Moran

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