The Centers for Medicare & Medicaid Services (CMS) have sent out a “reminder” that expanded ordering/referring provider claim edits are still not being applied against ordering and referring providers who do not have records in the Provider Enrollment, Chain, and Ownership System (PECOS).
A June 10 bulletin said, “As previously stated, CMS will give providers ample notice before the ordering/referring provider claim edit is applied.”
The ongoing PECOS saga gained widespread attention in the DME industry in October 2009, when CMS began notifying DME suppliers via “informational messages” whenever a claim involved a physician or other prescriber who was not yet registered in PECOS.
CMS had announced its intention to deny DME claims if the prescribing physician or other healthcare professional was not enrolled in PECOS. Suppliers were alarmed by how many “informational message” warnings they were receiving – an indication that a large number of physicians and other prescribers of DME were not registered in PECOS.
DME suppliers were also concerned because CMS’ plans seemed ultimately to penalize DME suppliers for physicians’ failure to enroll, and because the PECOS enrollment process was difficult and lengthy.
After DME industry protests that beneficiary access to equipment would be impacted if claims were denied, and after multiple implementation postponements, CMS issued a bulletin on Nov. 24 that said, “The automated edits will not be turned on effective Jan. 3, 2011. We are working diligently to resolve enrollment backlogs and other system issues and will provide ample advanced notice to the provider and beneficiary communities before we begin any automatic nonpayment actions.”
