BALTIMORE — HME providers listening in on a Jan. 20 Open Door Forum got an update on the PECOS, then gave CMS officials an earful on how things are going with physician registration in the new Provider Enrollment, Chain and Ownership System. The upshot? Not so good, some said.
According to Pat Peyton, Division of Provider/Supplier Enrollment, CMS has added NPIs to "more than 220 enrollment records" and expects to post a file on its Web site (www.cms.hhs.gov/medicareprovidersupenroll) in the next two weeks with the names and NPIs of physicians and other practitioners eligible to order and refer under Medicare. The file will be updated and replaced each month, Peyton said.
About the claims warnings resulting from the new PECOS edits, Peyton said, "We do know that since we added those NPIs, the number of informational messages has gone down."
She also cautioned listeners to remember that "just because somebody submits an enrollment application over the Web or mails it into the contractor … does not mean that, bingo, you have a record in PECOS. The enrollment contractor has to review that information, verify information, etc. It can take them 45, maybe even 60 days to do all that, so it's not instantaneous."
The update brought a barrage of questions and comments from HME providers across the country, with several from Alabama provider Carey Jinright. In the first place, he wanted to know, why are DME suppliers in the position of having to work with physicians to register in the system?
"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?" Jinright questioned.
While "we are seeing a large increase in the number of physicians enrolling in the Medicare program," responded CMS' Jim Bossenmeyer, the agency will continue to monitor the situation over the next couple of months.
"Pardon me, guys, for not being as optimistic about this PECOS situation as others," Jinright persisted in a second question, "but if my physicians do not follow through … if a patient comes into my facility with an order from a doctor that is not PECOS-registered, what are my options to provide service to that patient? Do I have an ABN option? Do I have a cash option? Or can I not provide service to this patient because she went to a doctor who is not enrolled in PECOS?"
Responded Bossenmeyer, "I'll have to get back with you on that one," adding that the information would be available on the next Open Door call (March 10).
But in a third comment, Jinright pointed out, "You guys truly hold the answer to the future of our company, and I take this very seriously … The problem that I'm running into is we are not seeing any decrease at all in our warnings."
His physicians, he said, "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.'"
Added Jinright, "With all due respect, I think every supplier that's listening right now has the same concerns."
One New York provider certainly did.
"Wouldn't the easiest way to get the physicians to comply with PECOS be to stop their Medicare payments?" she asked. "I think I speak for every supplier when I ask that question. You would be bombarded with applications next week."
CMS officials on the call also gave updates on:
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Competitive bidding. With the covered document review process complete, the agency is now evaluating Round 1 bids and, based on its current timeline, will announce payments in June and contract winners in September, said CMS' Joel Kaiser.
Responding to a question about the number of bids CMS had received and whether there were enough, Kaiser said "it will be some time before we identify any possible areas where there is an insufficient number of bids to meet our projected demand."
As for Round 2, Kaiser reminded listeners the products to be included would be "at the agency and department's discretion."
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The PAOC. The next meeting of the Program Advisory and Oversight Committee is scheduled Feb. 23 at CMS headquarters in Baltimore. The all-day meeting is open to the public, and information will be posted soon on how to register.
To hear a replay of the call, dial 800/642-1687 and use Conference ID 45247192. The recording expires today (Jan. 25).
