Home Health & Hospice Week

Home care providers might have more luck with getting their referring physicians to enroll in PECOS now that Medicare and its contractors are pushing the point.

"You have no doubt heard that [the Centers for Medicare & Medicaid Services] is requiring that all Medicare providers revalidate their Medicare provider enrollment information," said National Government Services' Jim Bavoso during a Part B Jurisdiction 13 Ask the Contractor Teleconference, hosted by NGS on Sept. 13. "In a nutshell, CMS is asking any provider who is not currently in the PECOS system to enroll, and to do it quickly."

Docs don't have to do anything about PECOS at the moment -- instead, they are waiting for their carriers to send them a letter. The MACs have identified all of the providers that aren't in PECOS, and each MAC is putting together letters to those practices to let them know they need to join PECOS. "We are sending letters to these doctors on a staggered basis, and we began this process last week," Bavoso added.

Physicians probably won't be any happier about doing the paperwork to enroll in PECOS. But at least it will be CMS that is the bad guy this time around, and not home care providers, industry veterans note.

Background: CMS had scheduled automatic edits checking for referring physicians' PECOS enrollment to start rejecting home care claims in July 2010. Home care providers panicked when they couldn't persuade all of their referring physicians to use the online enrollment system. Then CMS delayed the implementation of the rejection edits indefinitely while it sorted out PECOS problems with physicians (see Eli's HCW, Vol. XX, No. 23, p. 183).

Hopefully when the new PECOS edits take effect, most of those referring physician PECOS problems will be solved, home care execs say. CMS has yet to set a date for the rejection edits to begin. Home care claims currently undergo informational  edits on the topic that don't affect reimbursement.

Another hassle: Even if your referring physicians enrolled in PECOS last year, they'll have to repeat some of the PECOS paperwork as part of Medicare's revalidation effort. Anyone who is in PECOS but has not made changes since before March 25, 2011, will be asked to revalidate their information.

When physicians receive a revalidation request letter from their MAC, they will simply have to check their PECOS listings, and if they are accurate they'll just need to sign and revalidate the listing. If they need to make changes, they will do so at that point.

One caller complained that her physicians just enrolled in PECOS last November -- less than a year ago -- so she was concerned that she'll still have to revalidate since she hasn't changed her information since March 25, 2011. Although the NGS rep acknowledged that CMS made the rules and NGS is just passing on the information, Bavoso said the revalidation will be somewhat painless. "You'll just go into PECOS and review that provider's file, and if there's no change, then it's done." However, another NGS rep added, you will have to ask each provider to sign a signature statement and mail that in, even if you have no changes to that provider's file.