PECOS update: This could be big

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06/30/2010

John Shirvinsky, the executive director of the Pennsylvania Association of Medical Suppliers (PAMS) sent me this email a few minutes ago. This is such important information that I asked John if I could share his email and he said yes. So here it is:

I just received a call from the PA Medical Society telling me that they are receiving calls from physicians who are being advised by long term care facilities, pharmacies and HME providers that effective July 6, 2010, they will no longer accept prescriptions for oxygen and other DME from physicians who are not currently registered with PECOS.  This is apparently happening all over the country.  The AMA has advised the state medical societies to expect an announcement from CMS today on the subject.  They gave no indication what the announcement will be, but one would hope that they will finally clear up the confusion between the July 6 effective date and the January 3 implementation date.  It would be insane to enforce the earlier deadline at this juncture.

As you know, (industry attorney) Jeff Baird has weighed in that the discrepancy creates the likelihood that auditors will disallow claims paid between those dates.  In other words, we need something more than a wink and a nod from CMS.  PMS says that the Highmark Blue Shield, their Part B contractor, has advised them that January 3 remains the only date that CMS has officially advised them on and that they will pay all Part B claims that are submitted regardless of PECOS status.  PMS reports that the current backlog for obtaining a PECOS registration from CMS is 3-6 months; which is no better than it had been earlier this year.  During the May POE Advisory Committee meeting CMS advised us that PECOS warnings had dropped from 6 million per month to 3 million per month.  This is a big improvement, but 3 million is still a very large number.

This program has been badly mismanaged from the get-go.  We will watch for an announcement from CMS later today.

All I can add to this is: Stay tuned.

Mike Moran