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FOR IMMEDIATE RELEASE |
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CONTACT:
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CMS Media Affairs |
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June 30, 2010 |
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(202) 690-6145 |
CMS TO REVIEW PECOS ENROLLMENT PROCESS
Medicare Working with Ordering and Referring
Providers and Suppliers to Streamline Enrollment
Process
The Centers for Medicare & Medicaid Services (CMS)
is working with providers to address concerns about
enrollment in the Provider Enrollment, Chain and
Ownership System (PECOS) to ensure that Medicare
beneficiaries continue to receive the health care
services and items they need. PECOS is the
electronic system used to enroll physicians and
eligible professionals into the Medicare program.
As part of those efforts, CMS will, for the time
being, 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. 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 is
continuing to update and streamline the process, and
more providers have been enrolled in the past few
days.
CMS issued an interim final regulation on May 5,
2010 implementing provisions of the Affordable Care
Act 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.
The Affordable Care Act provisions and the
regulation were designed as steps to prevent fraud
in Medicare by ensuring that only eligible and
identifiable providers and suppliers can order and
refer covered items and services to Medicare
beneficiaries.
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.
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.
Additionally, though CMS is taking a more
deliberative approach to using the PECOS enrollment
system, the agency will employ a contingency plan to
meet the ACA requirement that written orders and
certifications are only issued by eligible
professionals effective July 1.
CMS will continue to send informational notices to
providers reminding them of the need to submit or
update their enrollment and will work with the
provider community to provide guidance on enrollment
and will process all applications expeditiously.
# # #
Question:
If a
physician has opted-out of Medicare, according to
the IFR they do NOT need to be in PECOS.
Answer:
I strongly
recommend that physicians who think they fall into
this category to call their Medicare contractor and
confirm they are listed as opted out. At this time,
CMS has not outlined a specific process for the opt
out affidavit. We hope that will be addressed in the
final rule. Website for Medicare contractors is
here if a physician does not know who to call. |
