Physician deadline for Medicare PECOS enrollment moved up to July

Washington -- Physician practices that are having problems with Medicare's enrollment system say their headaches are sure to increase if the Obama administration sticks with its new July deadline for most physicians to be signed up with PECOS, the Provider, Enrollment, Chain and Ownership System.

The new enrollment compliance date for doctors who order or refer most types of covered Medicare services and items is six months sooner than expected. Physicians have been operating under the assumption that they had until Jan. 3, 2011. The previous April 5 deadline had been postponed in mid-February, at the behest of the American Medical Association and other doctor organizations.

But an interim final rule that the Centers for Medicare & Medicaid Services published May 5 changed the date again. CMS said a new mandate from the health system reform law forced the deadline change.

The AMA and more than 40 other physician organizations contend otherwise, noting in a May 28 letter to CMS that the regulation goes beyond what is called for in the health reform statute. According to the legislation, the groups say, only physicians who order and refer durable medical equipment, prosthetics, orthotics and supplies, or home health services are required to be enrolled with Medicare through PECOS by July 1. However, CMS also is requiring that doctors who order or refer imaging, laboratory and specialist services be enrolled by July 6.

The organizations urged CMS to stick to the intent of the health reform law and revert to the Jan. 3, 2011, deadline for physicians ordering or referring services other than DMEPOS and home health. Doctors who opted out of Medicare are exempt from the requirements.

"Significant outreach has already been undertaken by CMS and our organizations to communicate to clinicians the January deadline," said the May 28 letter, which was addressed to acting CMS Administrator Marilyn Tavenner. "Past changes to the Medicare enrollment process, particularly ones involving substantial policy changes such as this one, have proven the need for a thoughtful and sufficient implementation timetable."

One big problem with the PECOS requirement, physicians say, is that it has the potential to interrupt their Medicare cash flow through no fault of their own. After the deadline, if a physician submits a Medicare claim that lists the name of the referring/ordering physician and that doctor is not enrolled in PECOS, the claim might be rejected.

The AMA and the other groups noted in their letter that CMS has the discretion to limit the scope of physicians impacted by the July deadline. Compounding the problem, they said, is the fact that many physicians and practices have had problems properly enrolling in PECOS, which CMS touts as a more accurate and secure system, and one that reduces paperwork.

Beyond requesting a switch back to the Jan. 3, 2011, enrollment date, organized medicine urged CMS to:

• Refrain from rejecting claims for imaging, laboratory or specialist services prior to January 2011 solely on the basis that the referring/ordering physician is not yet in PECOS.
• Increase contractor resources to support enrollment workload and to ensure that backlogs are avoided, customer service lines are answered promptly, and information submitted by physicians is not lost.
• Improve customer service training so physicians consistently receive the correct information.
• Develop an aggressive enrollment outreach campaign.
• Work with the medical community to ensure doctors understand their enrollment responsibilities.

At this article's deadline, the AMA was working with CMS on ways to mitigate the impact of the July 6 date, including an option to ensure that claims processing is not interrupted.

An "archaic" system

Paul J. Sorell, MD, is one physician who ran into a series of difficulties when he attempted to enroll in PECOS last fall. He manages a physical medicine and rehabilitation practice in Huntington, N.Y.

Dr. Sorell moved to a new location in September 2009, after a fire destroyed his previous office. He said he logged all the necessary updates with Medicare but found that after he tried to re-enroll, he received a letter saying he had been removed from the program. CMS mistakenly had an address on his file that was 6 years old, from when he first started his own practice on Long Island.

When he attempted to fix the problem -- first online and then over the phone with customer service -- he said he received little information.

"We were trying to go through PECOS, but that was a nightmare, because it's a very constrained system with several archaic questions," said Dr. Sorell, a pain medicine specialist.

With assistance from the AMA, Dr. Sorell said he was able to resolve his problem and get his status updated correctly with Medicare. But he said he couldn't imagine what colleagues would have to go through if the July 6 deadline stands, particularly after he spent four hours one day late last month just trying to resolve his PECOS-related glitches.

"They're totally legislating out the ability to take care of patients," Dr. Sorell said. "You have to jump through so many hoops in terms of this administrative stuff. Just when you think you've got it figured out, they'll ask you what color is the sky."

Adding to the confusion is the fact that CMS has moved the date before.

Originally, the deadline was Dec. 31, 2009, delayed to April 5, 2010, and then to Jan. 3, 2011.