AAHomecare: CMS Will Not Deny Non-PECOS Claims on July 6

In a Centers for Medicare & Medicaid Services (CMS) DMEPOS Open Door Forum last week, CMS' Jim Bossenmeyer reiterated that the Provider Enrollment, Chain, and Ownership System (PECOS) compliance date of July 6 will stand - which seemed to suggest that DME claims not abiding by PECOS rules could be subject to denial.

But in something of a clarification yesterday afternoon, the American Association for Homecare (AAHomecare) said it has heard from CMS officials "that Medicare DMEPOS claims will not be denied on July 6, 2010, if the claims are not PECOS compliant."

CMS has indicated multiple times, including in last week's Open Door Forum, that July 6 is the date that DME suppliers submitting Medicare claims will need to start including the physician's (or other prescriber's) national provider identifier (NPI) number and legal name per PECOS rules.

At the May 26 Open Door Forum, Bossenmeyer said that starting on July 6, CMS can start conducting administrative reviews of DME claims that don't adhere to PECOS rules. He said the compliance date would stand, despite acknowledging that CMS has received feedback that the July 6 deadline is too soon.

Bossenmeyer did not extrapolate on whether or not the administrative reviews would result in claims denials.

The recently signed Patient Protection & Affordable Care Act has brought a new urgency to PECOS requirements. The May 5 Federal Register included an interim final rule with a comment period that lasts until July 6, adding, "These regulations are effective on July 6, 2010."

In a June 2 bulletin, AAHomecare wrote, "CMS is seeking public comments on the effective date when claims that are not compliant with PECOS will be denied. Public comments on the rule, CMS-6010, which was published as an 'interim final' rule, must be received by July 6, 2010. The interim final rule, however, is not effective until CMS publishes a final version of this rule later this year."

AAHomecare added that it intends to submit comments, including "a recommendation as to when CMS should begin denying claims without appropriate legal name and associated National Provider Identifier of the ordering physician or clinician. A key consideration in deciding upon a claims denial date will be an assessment of the number of physicians and clinicians not enrolled in PECOS."

Comments can be submitted electronically by going to regulations.gov and following instructions for submitting comments on the home page. Suppliers can also submit written comments by sending them to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-6010-IFC, P.O. Box 8013, Baltimore, MD 21244-8013.

The interim final rule "implements the provision which requires all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs. This interim final rule with comment period also requires physicians and eligible professionals to order and refer covered items and services for Medicare beneficiaries to be enrolled in Medicare. In addition, it adds requirements for providers, physicians, and other suppliers participating in the Medicare program to provide documentation on referrals to programs at high risk of waste and abuse, to include durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), home health services, and other items or services specified by the Secretary."

The July 6 deadline caused confusion because that date is almost six months earlier than the Jan. 3, 2011, deadline previously given. Under questioning, Bossenmeyer appeared careful not to go into detail about how the July 6 deadline would or could affect the January date, repeating only that starting July 6, claims without the required NPI and other identifying information could be subject to administrative review.

About the Author

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

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