PECOS Implementation Is Delayed

The Centers for Medicare & Medicaid Services (CMS) has indefinitely postponed its implementation of the automated edits function within the Provider Enrollment, Chain, and Ownership System (PECOS).

The edits function would automatically deny DME claims if the prescribing physician or other healthcare professional is not registered in PECOS.

All year, controversy has surrounded PECOS implementation - which requires DME prescribers to register with Medicare, but in essence ends up penalizing DME suppliers and beneficiaries for physicians' failure to do so. Information on implementation dates has been vague and conflicting, with the most recent launch date interpreted to be Jan. 3, 2011.

But on Nov. 24, Michael Reinemer, VP of communications and policy for the American Association for Homecare, alerted members that the edit portion of PECOS had been delayed.

Reinemer said in the bulletin that CMS "informed us today that the January 3 effective date for PECOS edits has been indefinitely postponed. There is no target date for when an edit that would result in a front-end rejection would be implemented.

"However, we have been assured that such an edit would not go into effect until everything was 'in place.' We were also told that CMS would provide adequate notice in advance of implementing such edits. This notice would be provided not only to homecare providers but clinicians and beneficiaries."

Yesterday, a bulletin from National Government Services (NGS), the Jurisdiction B DME MAC, said, "At this time CMS has not turned on the automated edits that would deny claims for services that were ordered or referred by a physician or other eligible professional simply for lack of an approved file in PECOS."

The NGS update referenced a PECOS "backlog and other systems issues," and promised CMS would provide advance notice before making the edits system active.

"While there are some rumors that the edits will be turned on in January," the bulletin added, "we want to reiterate that CMS has not announced anydate (sic) - January 3 or otherwise - as to when ordering/referring edits will be turned on."

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at

Mobility Management Podcast