Headline News

Say What about the PECOS?









      
Jul 9, 2010 - 7:10 pm

  
  


	

	

BALTIMORE — The question has been asked any number of
times now in any number of ways: What exactly is the deal with
PECOS compliance regarding DME claims?


The industry's latest attempt at getting a straight answer came
from the American Association for Homecare's Walt Gorski, vice
president of government affairs, on a CMS Open Door Forum July
7.


The background:


The deadline for physician and other prescriber enrollment in
the Provider Enrollment, Chain and Ownership System was Jan. 3,
2011, but in order to be compliant with the new health reform law
(Affordable Care Act, or ACA), CMS pushed that deadline up to July
6 in an interim final rule.


In a June 30
announcement, the agency said it would "for the time being not
implement PECOS edits 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."


But the announcement gave providers no assurance that, in future
audits, they wouldn't have to give back their Medicare
reimbursements based on claims submitted from July 6 to Jan. 3 if
the ordering physician was not enrolled in PECOS.


So, AAHomecare's Gorski asked:


"Will [you] address that specific issue, that CMS and its
contractors will not seek recoupment from claims that are receiving
warnings during this period?"


Jim Bossenmeyer, CMS director of provider enrollment, responded
this way:


"There are a number of reasons why Medicare may recoup
money."


He added that DMEPOS suppliers should:


    

  • Make sure their claims contain the legal name of the physician
or other eligible professional along with their Type 1 NPI;
    • 

  • Make sure the individual is licensed to practice in the state
and has not been excluded from the program by the Office of
Inspector General;
    • 

  • Keep documentation from orders for services referred to them;
and
    • 

  • Work with their referral sources to make sure they know there
is a requirement for PECOS enrollment.
    • 



Gorski tried again: "If we do that and a ZPIC or RAC audit
occurs in 2012 and they look and see the effective date of the IFR
and see that the referring physician was not enrolled in PECOS, you
are telling the supplier community that the money will not be
recouped?"


To which Bossenmeyer replied: "I have not said that. I
understand what you would like me to say, but I cannot give you
that answer today."
	


			
	

  


  

    

          
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