Home Health & Hospice Week

Home care providers are still waiting to hear when Medicare will turn on its so-called PECOS edits, which will check for a referring/ordering physician’s record in PECOS. But one problem may be that the PECOS information isn’t so reliable.

The OIG recently reviewed provider enrollment files and found that many of them were wildly inaccurate, while others were incomplete. The OIG report, "Improvements Are Needed to Ensure Provider Enumeration and Medicare Enrollment Data Are Accurate, Complete, and Consistent," involved reviewing a random sample of individual Medicare providers to determine how accurate the provider information was in NPPES and the more recent PECOS system. As a result, the OIG found that 48 percent of NPPES records were inaccurate, but that a startling 58 percent of PECOS records were inaccurate, while another 4 percent were incomplete.

The OIG also found that provider data was inconsistent between NPPES and PECOS for a full 97 percent of the provider records. The main culprit? Addresses — which are essential for contacting providers — were the main source of inaccuracies and inconsistencies.

Part of the problem stemmed from the fact that the Centers for Medicare & Medicaid Services did not verify most provider information in either enrollment system, the OIG says. The agency urges CMS to verify more enrollment records and to detect and correct issues that it finds. CMS agreed with these recommendations.

The report is at http://go.usa.gov/b4MC.

Background: CMS announced it was de-laying the PECOS edits temporarily back in April (see Eli’s HCW, Vol. XXII, No. 15). No new implementation date has been set.