Home Health & Hospice Week

The looming PECOS edits may still cause you major headaches, but at least those problems are more than half a year away now.

Background: Starting April 5, the Centers for Medicare & Medicaid Services had planned to edit durable medical equipment and other Part B claims for the ordering or referring physician's National Provider Identifier. The edit would check whether the physician's NPI was in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS).

The claims system currently has an informational edit on the topic, but starting next month the edit would have begun rejecting claims.

Now: After an avalanche of complaints from suppliers, physicians, and other providers,  CMS has put off that date until next year. During a Feb. 17 special Open Door Forum on enrollment, CMS's Jim Bossenmeyer announced the postponement. Repeating the information twice because of its importance, Bossenmeyer said, "CR 6417 and CR 6421 have been delayed until January 3, 2011."

Suppliers were panicked because big portions of their ordering physicians weren't enrolled. And physicians were frustrated because they were experiencing problems with the enrollment process and long wait times for help.

"PECOS is a classic example of the documentation and administrative burden that is part of doing business with Medicare," American Association for Homecare President Tyler Wilson says in a release. "In many cases, the rules and regulations create almost impossible demands for filing claims."

Good outcome: "I am glad to see the agency pull back from the brink of implementing such an impractical requirement," Wilson added. But to avoid a repeat of the crisis, suppliers need to keep up the campaign to get ordering physicians enrolled in the system. "Please don't relax your efforts to get your physicians registered," exhorts the National Association of Independent Medical Equipment Suppliers. "Complacency now will result in physicians still not being registered in November and December."

AAHomecare would like to see CMS give docs a stake in the process. "Ideally, we would like to see some sort of requirement that ties physicians to the PECOS enrollment process," the trade group says. "Their claims were not in jeopardy, but ours were. The burden should not be placed on the HME provider to press physicians to enroll."