Docs Ask for PECOS Delay

BALTIMORE — HME providers aren’t the only ones worried
about physician registration in CMS’ new Provider Enrollment, Chain
and Ownership System (PECOS) database. On Monday, the American
Medical Association and more than 50 other physician and related
organizations requested that the agency delay its plan to deny
claims if the referring/ordering physicians are not in the
system.

According to CMS’ current schedule, any DMEPOS claims from
non-enrolled physicians will reject
come Jan. 4, 2010. Some HME providers have reported receiving
warning messages for as many as 80 percent of their claims noting
that those claims would not pass muster once the deadline kicks
in.

The physician groups estimated that, based on data from an
October OIG report, “as many as 200,000 or 30 percent of all
Medicare physicians and other health care practitioners are not in
PECOS and will need to re-enroll.

“The repercussions for this ill-advised policy are enormous,”
the groups said.

In their letter, addressed to CMS Acting Administrator Charlene
Frizzera, the organizations said, “Implementing this policy as
scheduled will cut off access to care for millions of Medicare
beneficiaries, interrupt reimbursement for legitimately provided
items and services, interrupt care coordination, and add unfunded
administrative mandates on a significant portion of physicians and
other health care practitioners who provide care to Medicare
beneficiaries.

“The impact of this policy has not been adequately considered by
the Centers for Medicare and Medicaid Services (CMS) or explained
to contractors, physicians, other health care practitioners, and
beneficiaries.”

The groups asked CMS to take the following “immediate” steps to
address the situation:

• Take action to ensure that otherwise acceptable claims are paid
  without delay or need for appeals;

• Indefinitely suspend the plan to deny these claims and instead
  wait at least until all practicing Medicare physicians, other
  health care practitioners, and residents can be revalidated and
  reenrolled or enrolled for the first time;

• Focus its efforts on ensuring a smooth and efficient
  revalidation process, which will require physicians and other
  health care practitioners to re-enroll in Medicare if they have not
  done so since 2003; and,

• Convene a high-level meeting with stakeholders to discuss
  concerns about ordering and referring physicians and other health
  care practitioners, and collaboratively develop a feasible and
  appropriate plan and timetable for addressing these concerns.

“We understand that CMS is under considerable pressure to reduce
fraud and abuse in the Medicare program and support those goals.
However, we do not believe the new policy to be consistent with
statutory authority, nor is it an effective or appropriate approach
to achieve its desired goal …” the letter continued. “Orders
and referrals are fundamental components of quality health care
delivery that should not be discouraged or hamstrung merely for
administrative needs that do not justify the corresponding
administrative and financial burden on physicians and other health
care practitioners.

“We believe the new policy impedes patient access to care, bogs
down the enrollment system further, and presents significant
workflow challenges to physicians and other health care
practitioners who will have little way to be sure whether another
physician is in the PECOS database.”

On Monday (Nov. 16), CMS sent out a notice that it had scheduled
an Open Door Forum
call for physicians and other health care practitioners on the
PECOS for this afternoon (Nov. 17).