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OIG Adds To Blame-The-Providers Dogpile At Carriers

Published on Wed Apr 11, 2007

Report cites providers' dragging their feet when responding to requests for info.

If you're frustrated by Medicare-enrollment delays, they may be your own fault, according to a new report from the HHS Office of Inspector General (OIG).

There were two reasons for long delays in processing enrollment applications after Medicare instituted the Provider Enrollment, Chain and Ownership System (PECOS) as of July 2005, the OIG says in report 07-05-00100. First, one Part B carrier had a backlog of applications waiting to be processed that accounted for 52 percent of the nationwide total. This carrier couldn't explain the delays.

And secondly, 41 percent of applications nationwide were held up because providers didn't respond to requests for information that was missing or incomplete on their applications. This finding could strengthen the carriers in blaming providers, instead of their own shortcomings, for enrollment delays.

The OIG did note that 61 percent of Medicare contractors had problems accessing PECOS. The carriers reported that the Centers for Medicare & Medicaid Services sent them messages telling them to use PECOS only during certain hours of the day. The carriers also had a problem getting or using PECOS user IDs for their own employees, and this made it harder for them to process applications quickly.

That the OIG chooses to blame providers for enrollment problems is unfortunate, notes consultant Leslie Witkin with Physicians First in Orlando, FL. In the case of the enrollment problems that have bedeviled Florida for the past year, providers haven't been making any more mistakes than they were previously, but the carriers have gone from quick turnaround to never-ending delays. "It doesn't seem to add up," says Witkin.

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