Home Health & Hospice Week

If the feds persist in enforcing the new PECOS rule so abruptly, 20 to 40 percent of home health agency patients could require discharge.

So warns the National Association for Home Care & Hospice. NAHC is working closely with congressional staff to find a resolution to the Medicare Provider Enrollment Chain and Ownership System (PECOS) problem, it says (see related story, p. 186).

Right now, "NAHC is not advising providers to discharge patients whose physicians are not in the PECOS record," the trade group tells members. "We believe that a solution will be found shortly," advises William Dombi, NAHC's vice president for law.

In the meantime, HHAs can follow these steps to address the PECOS problem, NAHC and the Texas Association for Home Care & Hospice say:

• Validate your referring physicians' PECOS information with CMS's physician PECOS file. You can access CMS's PECOS file at www.cms.gov/MedicareProviderSupEnroll -- click on "OrderingReferringReport" in the left-hand column and scroll down to the "Downloads" section.

(For instructions on how to check your docs, see related box, this page).

• Contact physicians whose enrollment you are unable to confirm. Verify that you're using their legal name and correct National Provider Identifier number. If so, request to receive a copy of  any PECOS confirmation they have received from CMS. You can "accept that as proof of PECOS enrollment," NAHC advises.

For a sample form letter to send physicians, see p. 188. NAHC and TAHC also offer model letters for both physicians and discharge planners on their websites.

• Inform non-enrolled physicians that they need to enroll and why. Tell them that under the new rule, you can't furnish services to patients with orders from non-enrolled physicians.

• Notify all referral sources, including hospitals, of the new PECOS rule. Tell them that under the new rule, you can't furnish services to patients with orders from non-enrolled physicians.

• Inform all patients of physicians not enrolled in PECOS of your inability to bill Medicare for their services and their financial liability for any care provided.

• Provide patients of non-enrolled physicians with a Medicare Expedited Determination Notice and a home health advance beneficiary notice (HH ABN) prior to any service termination.

Tip: Make sure you comply with agency policies and state law regarding patient notification prior to termination of services, NAHC counsels.

• Submit comments on the rule putting in place the July 6 deadline for the PECOS requirement. The notice is at http://edocket.access.gpo.gov/2010/pdf/2010-10505.pdf.