Home Health & Hospice Week

Although CMS hasn't officially postponed the PECOS edits for physicians who receive referrals from another physician, the unofficial postponement is likely to increase headaches for home care providers.

Background: Back in October, the Centers for Medicare & Medicaid Services delayed PECOS phase 2 edits for home health agencies until July 2011 (see Eli's HCW, Vol. XIX, No. 37, p. 290).Under phase 2 of the edits, Medicare will not reimburse claims unless the physician in the ordering/ referring slot is enrolled in PECOS. (Phase 1 informational edits for HHAs already began last month.)

But CMS didn't delay PECOS edits for physician claims as well. MLN Matters article MM6417, which CMS distributed on Feb. 26, 2010, put the edits' effective date at Jan. 3, 2011. But now CMS says those physician claim edits will not start in January. "While there are some rumors that the edits will be turned on in January, we want to reiterate that CMS has not announced any date (January 3 or otherwise) as to when ordering/ referring edits will be turned on," CMS said in a Nov. 29 e-mail to providers. "CMS is working diligently to resolve backlog and other systems issues and will provide ample advance notice to the provider and beneficiary communities before CMS begins any such automatic denials."

What this means for home care: If CMS turns on the physician edits soon, home care providers will have less work to do in getting their ordering physicians enrolled in PECOS before the July 5 start date for their own edits. Physicians may be more receptive to requests from other physicians to enroll to enable those doctors' Medicare payments to process, observers expect.