Home Health & Hospice Week
Medicare Issues PECOS Enrollment Instructions For Ordering Docs.
The Centers for Medicare & Medicaid Services is clearing one more obstacle from the path of the PECOS edits set to begin Oct. 4 for home health agencies. Physicians who do not seek Medicare payment but need to enroll in PECOS to order or refer patients for Medicare services can now do so, CMS says in Sept. 17 CR 7097. That includes docs who are employed by the Department of Veterans Affairs, Public Health Service, Department of Defense Tricare, federally qualified health centers, rural health clinics, or critical access hospitals; dentists and oral surgeons; and physicians in a fellowship. In fact, "any provider can enroll for the sole purpose of ordering or referring, regardless of who their employer is," CMS says in the transmittal. Such physicians must complete a paper form CMS-855I, sections 1, 2, 3, 13 and 15. And they must "include a cover letter with their paper form CMS-855I ... stating the provider is only enrolling for the sole purpose of ordering and referring items or services for a Medicare beneficiary to other providers and suppliers and cannot be reimbursed for services performed," CMS says in the transmittal. Unlike regular enrolling physicians, ordering/referring-only docs don't have to send the CMS 460 or CMS 588 forms along with the 855, the transmittal explains. Watch out: Interns and residents can't enroll this way. Providers will need to use their attending physician's NPI and information on the claim, CMS says. Informational edits for HHAs will begin Oct. 1. Edits that deny claims for lacking PECOSenrolled physician information will begin in January. The transmittal is online at www.cms.gov/transmittals/downloads/R355PI.pdf.
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