The Centers for Medicare & Medicaid Services (CMS) announced on June 30 that it is working with ordering and referring providers and suppliers to address concerns about enrollment in the Provider Enrollment, Chain, and Ownership System (PECOS). CMS stated in a press release that as part of those efforts, the agency will “not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010,” the current effective date for the PECOS program.
CMS issued an interim final regulation on May 5, 2010, implementing provisions of the Patient Protection and Affordable Care Act (PPACA) that permit only a Medicare-enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and certain items and services under Medicare Part B. The new law applies to orders, referrals, and certifications made on or after July 1. The comment period for the regulation closes on July 6, after which the comments will be reviewed and considered before a final regulation is issued, according to CMS.
“While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems,” CMS stated. “CMS is continuing to update and streamline the process, and more providers have been enrolled in the past few days…. Many physicians and other providers and suppliers have continued to make good-faith efforts to comply with the requirements of the law and regulation. These efforts will be a significant factor in determining the procedures and processes that will be incorporated in the final rule.”
CMS also noted that “while the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS. However, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid.”
CMS said that it will employ a “contingency plan” to meet the requirement specified in the PPACA that, effective July 1, written orders and certifications be issued only by PECOS-enrolled professionals.
The CMS press release referred specifically to claims based on orders, certifications, and referrals made by providers who have not yet had their PECOS applications approved by July 6, 2010, and to providers who have attempted to enroll in PECOS. The O&P EDGE has asked CMS for clarification about how it will treat claims that are based on orders, certificates, and referrals made by providers who have not attempted to enroll in PECOS, and for details about the contingency plan. We will post updates and clarifications as they become available.
