CMS Extends PECOS Deadline Till April

The Centers for Medicare & Medicaid Services (CMS) have delayed implementation of a DME-prescriber registration system that DME suppliers and advocates warned would endanger beneficiary access to medically necessary equipment.

The new deadline, announced last week, is April 5, 2010.

Medicare's Provider Enrollment, Chain and Ownership System (PECOS) is a database that is supposed to contain the enrollment records of all physicians and non-physician practitioners (including nurse practitioners, physician assistants) and clinical social workers eligible to prescribe DME.

In October, DME suppliers began receiving "informational messages" for claims that had been approved, but contained the names of prescribers not in the PECOS system. CMS said that in January, it would begin rejecting all claims for Part B DME that had been prescribed by a physician or non-practitioner not registered in PECOS.

Suppliers, alarmed by the high numbers of claims containing those informational warnings, protested that relatively few prescribing practitioners/physicians were enrolled in PECOS or even knew they were supposed to be. Suppliers also warned that access to DME would be severely restricted in January should the PECOS implementation date stand.

State associations and other supplier advocacy organizations pointed out that suppliers have no authority to urge physicians and practitioners to register in PECOS, though suppliers were reported to be working feverishly to educate to physicians.

In announcing the delay last week, CMS said it "will delay, until April 5, 2010, implementation of Phase 2 of Change Request 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors) and CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Supplier Claims Processed by Durable Medical Equipment Medicare Administrative Contractors. CRs 6417 and 6421 are applicable to Part B claims only."

The postponement, CMS added, "will give physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers sufficient time to enroll in Medicare or take the action necessary to establish a current enrollment record in Medicare prior to Phase 2 implementation."

DME suppliers had also voiced concern that the 60-day period between implementation of phase 1 (the inclusion of those "informational messages") and phase 2 (when claims would be rejected) was too short to enable physicians and practitioners to be educated and to complete the registration process, even if they began the registration process immediately.

CMS' announcement of the delay also contained educational information for physicians and practitioners that explained that they need to update their enrollment information if they have not done so since November 2003.

"If you are not enrolled in the Medicare program, or if you enrolled more than six years ago and have not submitted any updates or changes to your enrollment information in more than six years, you do not have an enrollment record in PECOS," the CMS announcement said. "In order to continue to order or refer items or services for Medicare beneficiaries, you will have to submit an initial enrollment application."

CMS added that physicians and practitioners who are enrolled in Medicare should still check to make sure their enrollment records are current.

Dentists, physicians with specialties such as pediatrics, and physicians employed by Veterans Affairs, the Public Health Service or the Department of Defense Tricare program will all need to enroll in PECOS to continue prescribing DME and related services to Medicare beneficiaries, CMS noted.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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