New PECOS Chapter to Begin for HME Providers

BALTIMORE — After scrambling for months to make sure their
referring and ordering physicians are enrolled in PECOS, DMEPOS
providers will be able to use the Internet-based system to manage
enrollment for themselves beginning in July, CMS officials
announced last week.

“They can begin to use [the Provider Enrollment, Chain and
Ownership System] to enroll, change enrollment or withdraw from the
program beginning July 13,” said Jim Bossenmeyer, director of CMS’
Division of Provider/Supplier Enrollment, on a Special Open Door
call May 19.

Instead of mailing CMS-855 paper forms, providers will be able
to use the online system to enroll, complete the re-enrollment
process and track the status of an application submitted through
the Internet, as well as view the information CMS has on file for
them, according to the agency.

Bossenmeyer had a caveat on the latter, however. “If you haven’t
updated your information since November 2003, PECOS will not have
any information and you will be required to submit an application,”
he said.

According to CMS, on July 5 all active DMEPOS provider data from
the National Supplier Clearinghouse will be transferred to
PECOS.

“This move will establish enrollment records in PECOS for all
active DMEPOS suppliers. PECOS currently contains the enrollment
records for Medicare Part A and Part B fee-for-service providers
and suppliers (with the exception of the DMEPOS suppliers). When
the DMEPOS supplier enrollment records are moved into PECOS, PECOS
will contain the enrollment information for all Medicare
fee-for-service providers and suppliers,” CMS says in its “Getting
Started” guide about the system.

The agency is making the system accessible to DMEPOS providers
now, although they will not be able to enroll or perform any other
tasks until July 13. The idea, officials said, is to allow them to
become familiar with the access procedures and features of the
system.

Providers can access the system with the user IDs and passwords
established when they applied to the National Plan and Provider
Enumeration System for their National Provider Identifiers.

Bossenmeyer also said further information would be available at
Wednesday’s (May 26) regularly scheduled Open Door Forum for
DMEPOS, home health and hospice. The call is scheduled for 2 p.m.
ET. To listen in, call 800/837-1935 and reference conference ID
73237510.

CMS officials hit on a number of other issues during the call,
but one particularly resonated with providers: the active date by
which all Medicare physicians must be enrolled in PECOS.
Bossenmeyer announced the compliance date as July 6; listeners,
however, had heard from CMS that the implementation date was Jan.
3, 2011.

Stakeholders wondered if they submitted claims for items and/or
services ordered after July 6 by a physician who was not enrolled
in PECOS, would the claim be denied?

A North Carolina caller was the first of several to question
Bossenmeyer in this exchange:

Caller: “I just wanted clarification on the
deadline … and that is the July 6, 2010, deadline … please
correct me if I’m wrong, is [that] the PECOS enrollment deadline
for DME or is that the PECOS enrollment deadline for ordering and
referring that changed from Jan. 3 of 2011?”
Bossenmeyer: “The regulation is effective as of
July 6, 2010.”
Caller: “So the regulation has come in, it’s not
necessarily the implementation. The Jan. 3, 2011, date is still
valid.”
Bossenmeyer: “Yes, ma’am.”
Caller: “Thank you. You’ve made my day.”

But providers remained confused by the two dates.

Mark Higley, vice president of development for Waterloo,
Iowa-based VGM Group, acknowledged that the information was less
than clear.

Higley said the recently-passed Patient Protection and
Affordable Care Act stipulates physicians and eligible
professionals who order items and/or services for Medicare
beneficiaries must have an approved enrollment in PECOS. The
sticking point, he said, is that the act’s interim final rule has
an effective date of July 1, and the CMS interim final rule
“provides an effective date 60 days from its publication, which
would be July 4, 2010.” Written comments may, however, be submitted
until July 6.

Since CMS had announced a delay of the PECOS edits (which
require verification of a referral source’s Medicare enrollment)
until Jan. 3, 2011, Higley said he believes “that beginning July 4,
if a claim is submitted for services in which the ordering or
referring physician or eligible professional does not have a PECOS
enrollment record, the provider or supplier submitting the claim
will, as before the delay, receive a remittance with an
informational message notifying the provider that the claim did not
contain the requisite ordering/referring provider information
… but will not be rejected.”

“Bottom line: The ‘drop dead’ date remains Jan. 3, 2011,” Higley
said.

For further information on using the Internet-based PECOS, check
CMS’
“Getting Started” guide for DMEPOS providers. The guide
includes a breakdown of the PECOS enrollment process for individual
and organizational providers, step-by-step instructions on how to
submit an online enrollment application, information on checking
the status of an application and FAQs.

For information on the PECOS system from industry consultant
Andrea Stark of MiraVista, see www.miravistallc.com/blog/?p=958.