CMS Delays PECOS
BALTIMORE — In a notice sent this afternoon, CMS said it
will delay implementation of the PECOS registration requirement for
ordering/referring physicians until April 5, 2010.
The notice follows in its entirety:
The Centers for Medicare & Medicaid Services (CMS)
will delay, until April 5, 2010, the implementation of Phase 2 of
Change Request (CR) 6417 (Expansion of the Current Scope of Editing
for Ordering/Referring Providers for Claims Processed by Medicare
Carriers and Part B Medicare Administrative Contractors (MACs)) and
CR 6421 (Expansion of the Current Scope of Editing for
Ordering/Referring Providers for Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Claims
Processed by Durable Medical Equipment Medicare Administrative
Contractors (DME MACs)). CRs 6417 and 6421 are applicable to Part B
claims only.
The delay in implementing Phase 2 of these CRs 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.
Although enrolled in Medicare, many physicians and non-physician
practitioners who are eligible to order items or services or refer
Medicare beneficiaries to other Medicare providers or suppliers for
services do not have current enrollment records in Medicare. A
current enrollment record is one that is in the Medicare Provider
Enrollment, Chain and Ownership System (PECOS) and also contains
the physician/non-physician practitioner’s National Provider
Identifier (NPI). Under Phase 2 of the above referenced CRs, a
physician or non-physician practitioner who orders or refers and
who does not have a current enrollment record that contains the NPI
will cause the claim submitted by the Part B provider/supplier who
furnished the ordered or referred item or service to be
rejected.
CMS continues to urge physicians and non-physician practitioners
who are enrolled in Medicare but who have not updated their
Medicare enrollment record since November 2003 to update their
enrollment record now. If these physicians and non-physician
practitioners have no changes to their enrollment data, they need
to submit an initial enrollment application which will establish a
current enrollment record in PECOS.
For physicians and non-physician practitioners who order or
refer:
-
If you are not enrolled in the Medicare program, or if you
enrolled more than 6 years ago and have not submitted any updates
or changes to your enrollment information in more than 6 years, you
do not have an enrollment record in PECOS. In order to continue to
order or refer items or services for Medicare beneficiaries, you
will have to submit an initial enrollment application. You may do
so either by (1) using Internet-based PECOS (which transmits your
enrollment application to the Medicare carrier or A/B MAC via the
Internet — be sure to mail the signed and dated Certification
Statement to the carrier or A/B MAC immediately after submitting
the application), or (2) filling out the appropriate paper Medicare
provider enrollment application(s) (CMS-855I and CMS-855R, if
appropriate) and mailing the application, along with any required
additional supplemental documentation, to the local Medicare
carrier or A/B MAC, who will enter your information into PECOS and
process your enrollment application. Information on how to enroll
in Medicare is found on the Medicare provider/supplier enrollment
web site at www.cms.hhs.gov/MedicareProviderSupEnroll. -
If you are already enrolled in Medicare, make sure you have a
current enrollment record. You can find out if you have an
enrollment record in PECOS by calling your designated carrier or
A/B MAC or by going on-line, using Internet-based PECOS, to view
your enrollment record. We will be posting information to the
Medicare provider/supplier enrollment web site that will guide you
through this process. Information about Internet-based PECOS and a
link to Internet-based PECOS can be found on the Medicare
provider/supplier enrollment web site. Before using Internet-based
PECOS, we recommend that you read the information that is posted
there and that is available in the downloadable documents
section. -
If you are a dentist or a physician with a specialty such as a
pediatrics who is eligible to order or refer items or services for
Medicare beneficiaries but have not enrolled in Medicare because
the services you provide are not covered by Medicare or you treat
few Medicare beneficiaries, you need to enroll in Medicare in order
to continue to order or refer items or services for Medicare
beneficiaries. -
If you are a physician who is employed by the Department of
Veterans Affairs, the Public Health Service, or the Department of
Defense Tricare program but have not enrolled in Medicare because
you would not be paid by Medicare for your services, you need to
enroll in Medicare in order to continue to order or refer items or
services for Medicare beneficiaries. -
If you are a resident who has a medical license but have not
enrolled in Medicare because you would not be paid by Medicare for
your services, you do not need to enroll in Medicare in order to
continue to order or refer items or services for Medicare
beneficiaries. The teaching physician — not the resident
— should be identified in claims as the ordering/referring
provider when a resident orders or refers items or services for
Medicare beneficiaries.
CMS actions to mitigate the number of informational
messages:
Since many Part B providers and suppliers are receiving a high
volume of informational messages in their Remittances, CMS is
taking the following actions to reduce the number of informational
messages being generated:
-
Prior to the implementation of Phase 2, CMS will systematically
add the NPIs to the PECOS enrollment records of all physicians and
non-physician practitioners whose enrollment records are in PECOS
but do not contain their NPIs. Because the NPI is one of the
matching criteria used in implementing the two new edits on the
Ordering/Referring Provider, it is essential that the NPI be in the
PECOS enrollment record. Because the data file used to implement
the two edits contains only the eligible physicians and
non-physician practitioners who are in PECOS with NPIs in their
enrollment records, this action will add many more physicians and
non-physician practitioners to that data file. -
Prior to the implementation of Phase 2, CMS will make publicly
available on the Internet the names and NPIs of the Medicare
physicians and non-physician practitioners who are eligible to
order or refer in the Medicare program. The name displayed will be
that of the physician or non-physician practitioner as it appears
in his or her PECOS enrollment record. This will allow Part B
providers and suppliers who furnish and bill for items or services
based on orders or referrals to determine if the Ordering/Referring
Provider being identified in their claims will pass the two new
edits prior to submitting the claims to Medicare. -
Prior to the implementation of Phase 2, CMS will issue
instructions to carriers and A/B MACs that will assist them in
processing enrollment applications from physicians who are employed
by the Department of Veterans Affairs, the Public Health Service,
and the Department of Defense Tricare program. The instructions
will also state that the teaching physician should be reported as
the Ordering/Referring Physician in situations where a resident
orders or refers items or services for Medicare beneficiaries. The
instructions will also note that dentists and pediatricians, who
sometimes order or refer items or services for Medicare
beneficiaries, may be enrolling in Medicare in order to continue to
order and refer. -
CMS will be preparing a Special Edition Medicare Learning
Network (MLN) Matters Article on the implementation of these two
new edits. This MLN Matters Article will expand upon the
information currently available in MLN Matters Articles MM 6417 and
MM 6421.
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