PECOS Edits Delayed until 2011

BALTIMORE — Home medical equipment providers working frantically to get physicians enrolled in the Provider Enrollment, Chain and Ownership System got a gift of time Wednesday when CMS announced it would delay planned — and controversial — PECOS edits until 2011.

"CMS is going to delay the implementation of [change requests] 6417 and 6421 until Jan. 3, 2011," Jim Bossenmeyer, CMS director of provider enrollment, told more than 1,000 relieved listeners on a Special Open Door Forum call.

The Internet-based PECOS allows physicians and other practitioners to enroll in Medicare, check on the status of an application or make a change in their enrollment information. Under the edits, if ordering/referring physicians or other non-physician practitioners listed on DME claims are not in PECOS, those claims will reject. CMS had originally set Jan. 4 as the effective date for the edits, but later pushed the date out to April 5.

The agency did not give a reason for the delay, but the American Association for Homecare did in its Wednesday afternoon newsletter.

"Facing overwhelming enrollment problems, CMS recognized that it was unable to implement PECOS on the scheduled implementation date of April 5, 2010," the association said, noting that it had been pushing for the delay and had reached out to the American Medical Association for support on the issue.

Last November, the AMA and more than 50 other physician and related groups wrote acting CMS Administrator Charlene Frizzera requesting that the agency delay its PECOS plans. At that time, the groups estimated "as many as 200,000 or 30 percent of all Medicare physicians and other health care practitioners are not in PECOS and will need to re-enroll."

CMS has said it is the responsibility of DME providers to ensure that the ordering physicians on their claims are registered in the PECOS. But that has caused an uproar among the industry's providers, who reminded agency officials that they have no authority over physicians and that there is no incentive for physicians to participate in the system.

On an Open Door call in January, Alabama provider Carey Jinright crystallized the problem. "I don't have control over my physicians, and many of them are much more interested in their own benefits than mine … so why is there not a consequence for their inaction?" he asked.

His physicians, Jinright told CMS representatives, "don't understand what is being asked of them and the importance of that. Their question to me is, 'Will my claims deny for my Medicare beneficiaries as of April?' and I have to say, 'Honestly, no, but mine will.'"

"Ideally, we would like to see some sort of requirement that ties physicians to the PECOS enrollment process. Their claims were not in jeopardy, but ours were," said Walt Gorski, AAHomecare vice president of government affairs. "The burden should not be placed on the HME provider to press physicians to enroll. Nevertheless," he said of the delay, "this is an excellent outcome."

Bossenmeyer said CMS would offer a little leverage that could  help providers get physicians enrolled.

"We're working with the physician community to ensure that all physicians and non-physician practitioners update their enrollment by January of next year," he said. Otherwise, they won't be able to order/refer under Medicare.

Bossenmeyer said CMS will be sending out revalidation letters to physicians who have not updated their information for six years. Medicare contractors began updating the PECOS with physician enrollments in November 2003; physicians who enrolled before then are not in the database. Physicians who have not billed Medicare within the last 12 months also need to file an application to revalidate, officials said.

 "We'll be validating that Medicare has current information on contractors it is paying," Bossenmeyer said.

He noted that in 2009, 10,000 revalidations were received and are still being processed. Because PECOS enrollment is ongoing, providers will continue to see warning messages on their GenResponse reports for claims that wouldn't pass muster under the edits.

Officials said the PECOS would be available for DMEPOS providers who want to enroll or update their own information online later in 2010.

While the PECOS delay was the hot news of the day, it was the system itself that garnered the most questions on the call. Numerous representatives from physician groups and others described frustrating glitches that ranged from the absence of a view function on the site and being referred to wrong numbers to getting conflicting information on questions.