When it comes to the Provider Enrollment, Chain, and Ownership System (PECOS) system, compliance dates have become a moving target, but the Centers for Medicare and Medicaid Services (CMS) said it won’t be giving providers any slack on claims. In a May 19 Open Door Forum, CMS spokesman Jim Bossenmeyer stated that according to an interim final rule pending comment (IFC) published on May 5 in accordance with the Patient Protection and Affordable Care Act (PPACA), the official PECOS compliance deadline is now July 6, 2010, six months sooner than the January 3, 2011, compliance deadline required in Change Request (CR) 6421. Bossenmeyer also stressed that after July 6, durable medical equipment, prosthetic, orthotic, and supplies (DMEPOS) providers will get no grace period for claims based on prescriptions from referring/ordering providers who are not PECOS enrolled.
Noncompliant, But Not Necessarily Rejected
In a June 8 interview with The O&P EDGE, Peter Ashkenaz, the deputy director of Centers for Medicare and Medicaid Services (CMS) media affairs, clarified that CMS’s current position is still that claims that are not PECOS compliant won’t actually be rejected until January 3, 2011. However, he added that “we expect DMEPOS suppliers to submit PECOS-compliant claims on and after July 6, and if they don’t…they’ll be in violation of the rules.” The consequences of violation are “yet to be determined,” he said, and confirmed that CMS reserves the right to retroactively review and deny claims based on their PECOS compliance. This means that noncompliant claims submitted after July 6 could potentially be denied retroactively.
“July 6 is the date that the interim final rule requiring PECOS compliance goes into effect,” Ashkenaz said. The IFC “is effective as the final rule but is still open for comment,” he explained. “Then we review all of those comments, and we look at our ability to make changes based on how it [the requirement] is described in the law…and make sure that we’re following the letter of the law, to make adjustments to the reg [regulation]. Or we come back and say to the commenters, ‘The law doesn’t allow us to do that.'”
Until the comments regarding the law have been reviewed, consequences for submitting claims that aren’t PECOS-compliant remain uncertain. Ashkenaz says that CMS hopes to release a final rule in midsummer, though CMS will continue taking comments on the IFC until 5 p.m. on July 6. To submit a comment, visit www.regulations.gov/search/Regs/home.html#submitComment?R=0900006480ae721a
Will CMS Be Ready By July 6?
Bossenmeyer also told Open Door Forum attendees that CMS is currently updating its system to allow it to audit for PECOS compliance, though the updates may not be functional by July 6. He did note that CMS plans to notify providers before the system updates, referred to as “edits,” go online and claims start being audited for compliance.
