NGS: CMS Won’t Reject Claims If Prescribers Weren’t in PECOS July 6

In the latest development in the ongoing Provider Enrollment, Chain, and Ownership System (PECOS) drama, National Government Services (NGS) issued an e-mail bulletin today saying DME claims involving prescribers not enrolled in PECOS on July 6 would not be automatically rejected.

NGS is the Jurisdiction B DME MAC.

Confusion involving two sets of dates - July 6, 2010, and Jan. 3, 2011 - has swirled for weeks as representatives for the Centers for Medicare & Medicaid Services (CMS) seemed to imply that they could sanction incoming DME claims if the prescribing physician or other healthcare professional had not registered in PECOS by July 6.

That possibility confused both DME suppliers and the prescribing physicians, because CMS had previously said physicians and other DME prescribers had till Jan. 3, 2011, to enroll in PECOS.

Today, a bulletin titled "CMS to Review PECOS Enrollment Process" said CMS is "working with providers to address concerns about enrollment in PECOS to ensure that Medicare beneficiaries continue to receive the healthcare services and items they need. As part of those efforts, CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications and referrals made by providers that have not yet had their applications approved by July 6, 2010."

The bulletin said more than 800,000 physicians and prescribers have enrolled in PECOS, but added, "Some providers have encountered problems. CME is continuing to update and streamline the process, and more providers have been enrolled in the past few days."

NGS also said, "While the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS. However, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid."

But the bulletin added, "Though CMS is taking a more deliberate approach to using the PECOS enrollment system, the agency will employ a contingency plan to meet the Affordable Care Act requirement that written orders and certifications are only issued by eligible professionals effective July 1."

CMS said it will continue to educate the physician and prescriber community about the necessity of enrolling in PECOS if they're prescribing DME to patients who are Medicare beneficiaries.

About the Author

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

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