Medicare Compliance & Reimbursement

But provider reps frustrated by slow progress.

The pace of the Provider Enrollment Chain and Ownership System (PECOS) couldn't get much slower - tens of thousands of providers are still waiting for enrollment or re-enrollment with Medicare.

The Centers for Medicare & Medicaid Services and Medicare carriers are making slow progress in coping with the delayed enrollments, but CMS predicts things will be back to normal within 60 days. "Normal" doesn't mean no pending applications, because the carriers each receive hundreds or even thousands of applications per month.

The number of pending enrollments was 72,595 in mid-August, down from an all-time high of 108,829 in April, CMS officials told a physician Open Door Forum on Aug. 23. The numbers are getting close to the baseline numbers from last October, before PECOS took effect.

Back in October, the carriers had 23,692 pending initial applications - they now have 30,666 pending initial applications. And the carriers are actually ahead on change requests, with only 11,263 pending now versus 12,402 last October. "We're making very good progress with reducing the backlog and working the new applications and the new change requests coming in," said a CMS official.

In late July, CMS implemented a "transitory database," which it expects to reduce the reassignment workload significantly.

But Bill Finerfrock, vice president of health policy with Capitol Associates in Washington, expressed concern that the backlog was still being reduced too slowly. He noted that the backlog was at around 80,000 applications as of July's ODF meeting, and had only gone down to 72,000 since then.

"The way [CMS] presented the numbers this time, it doesn't sound as though we made as much progress in the last 30 days as previously," Finerfrock said.

CMS officials responded that the agency expects to be back at baseline for all enrollments within 60 days. It's asked the carriers to name a number of pending applications that they believe they would need to have in order to meet timeliness requirements. Those carrier figures were expected in the third week of August.

One controversy that remains: If an X-ray takes place in one location and the physician reads it in another location, does the physician need to be enrolled in both places?

With advances in technology, physicians could interpret X-rays across state lines. CMS officials are working on a solution to this issue at the moment.