Medicare PECOS deadline extended again

Doctors now have until the end of the year to ensure that they are current on the Medicare enrollment system and avoid claims denials.

By Chris Silva — Posted March 8, 2010

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The Centers for Medicare & Medicaid Services once again has pushed back the date on which it will implement a new Medicare enrollment policy that threatened the timely payment of thousands of Medicare claims. The new deadline gives physicians more time to make sure they are signed up with PECOS, the Provider, Enrollment, Chain and Ownership System.

CMS had said physicians and group practices -- with few exceptions -- had to be enrolled in PECOS by April 5 if they wanted to continue having their Medicare claims accepted, but that deadline has been extended to Jan. 3, 2011. The agency said its new enrollment system speeds up the application process, reduces paperwork, and helps cut down on fraud and abuse. But the American Medical Association and other physician organizations pushed for more time, estimating that thousands of doctors still need to enroll in PECOS. Many of these doctors might not know that they need to re-enroll because they first signed up for Medicare before 2003, when CMS began using the new system.

This is the second time CMS has pushed back the deadline. The agency initially said it would start denying claims from noncompliant physicians on Jan. 1, before extending the effective date to April 5 after physicians raised concerns.

The Feb. 19 announcement from CMS came as a relief to the AMA and other physician organizations. They had been imploring the agency to recognize the constraints the doctor community was under already, including preparing for a 21% cut in Medicare pay and facing uncertainty over the ongoing health system reform debate.

"The AMA is pleased that CMS has followed the AMA's advice and again extended the deadline for referring or ordering physicians that must enroll in PECOS to Jan. 3, 2011," said AMA Chair-elect Ardis Dee Hoven, MD. "This will allow more time for all physicians and [medical equipment] suppliers who refer or order services for Medicare patients to get enrolled."

Getting referring physicians in line

Dr. Hoven said the AMA would continue to work with CMS on how to educate physicians on an enrollment process that many consider complex. One particular point of confusion and concern centers on the Medicare requirement that referring physicians, and not just treating physicians, also must establish a current enrollment record in PECOS for claims to go through.

"The performing physician would not get paid if the referring physician was not in the database, which can cause huge headaches," said Anders Gilberg, vice president of public and private economic affairs for the Medical Group Management Assn. He said some dentists and those who see or refer patients through the Dept. of Veterans Affairs and Tricare were out of the loop, and group practices needed to enroll multiple physicians.

"I think CMS realized they really needed to take a step back and re-evaluate the system," Gilberg said.

Larrie Dawkins, practice administrator and chief compliance officer for Wake Forest University Health Sciences in Winston-Salem, N.C., said the additional breathing room is welcome. He said some of the roughly 800 physicians at Wake Forest still need to re-enroll in PECOS to comply with the new CMS policy.

"Our provider enrollment office is proceeding to move forward to complete the task before the January deadline," Dawkins said. "I believe some practices will move forward, and others will take additional time."

The American Assn. for Homecare, which represents medical equipment suppliers that also must become PECOS-compliant, said CMS needs to launch an education campaign aimed at the supply firms. "Right now, the enrollment system is very cumbersome and confusing, and the home medical equipment suppliers and physicians don't fully understand why they need to enroll," said Walter Gorski, vice president of government affairs for the association.

For now, if a Medicare claim lists a treating or referring physician who is not properly enrolled in PECOS, Medicare will approve payment but will send back the claim with informational edits warning that it has been marked for nonpayment because of the enrollment issue. After the second phase of the policy implementation kicks in on Jan. 3, 2011, Medicare will start denying payment for claims on which physicians are still not PECOS-compliant. A current enrollment record is one that has been entered in the PECOS database since 2003 and that contains the physician's National Provider Identifier.

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How to enroll in PECOS

With few exceptions, physicians need to be enrolled in PECOS if they want to continue seeing or referring Medicare patients after the end of this year. Many who are not in PECOS enrolled in Medicare before the system's launch in 2003 and have not changed their information since then. CMS offers an online enrollment process. Applicants must:

  • Have or obtain a National Plan and Provider Enumeration System user ID and password. This is the same system that physician practices use to sign up for an NPI.
  • Complete, review and submit an electronic enrollment application on the PECOS Web site (link)).
  • Print, sign and date the two-page certification statement; mail it and all supporting paper documentation to the Medicare contractor within seven days of electronic submission.

Source: Centers for Medicare & Medicaid Services

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