PECOS Still Big Problem, Providers Tell CMS

BALTIMORE — HME providers listening in on a Jan. 20 Open
Door Forum got an update on the PECOS, then gave CMS officials an
earful on how things are going with physician registration in the
new Provider Enrollment, Chain and Ownership System. The upshot?
Not so good, some said.

According to Pat Peyton, Division of Provider/Supplier
Enrollment, CMS has added NPIs to “more than 220 enrollment
records” and expects to post a file on its Web site (www.cms.hhs.gov/medicareprovidersupenroll)
in the next two weeks with the names and NPIs of physicians and
other practitioners eligible to order and refer under Medicare. The
file will be updated and replaced each month, Peyton said.

About the claims warnings resulting from the new PECOS edits,
Peyton said, “We do know that since we added those NPIs, the number
of informational messages has gone down.”

She also cautioned listeners to remember that “just because
somebody submits an enrollment application over the Web or mails it
into the contractor … does not mean that, bingo, you have a
record in PECOS. The enrollment contractor has to review that
information, verify information, etc. It can take them 45, maybe
even 60 days to do all that, so it’s not instantaneous.”

The update brought a barrage of questions and comments from HME
providers across the country, with several from Alabama provider
Carey Jinright. In the first place, he wanted to know, why are DME
suppliers in the position of having to work with physicians to
register in the system?

“I don’t have control over my physicians, and many of them are
much more interested in their own benefits than mine … so why
is there not a consequence for their inaction?” Jinright
questioned.

While “we are seeing a large increase in the number of
physicians enrolling in the Medicare program,” responded CMS’ Jim
Bossenmeyer, the agency will continue to monitor the situation over
the next couple of months.

“Pardon me, guys, for not being as optimistic about this PECOS
situation as others,” Jinright persisted in a second question, “but
if my physicians do not follow through … if a patient comes
into my facility with an order from a doctor that is not
PECOS-registered, what are my options to provide service to that
patient? Do I have an ABN option? Do I have a cash option? Or can I
not provide service to this patient because she went to a doctor
who is not enrolled in PECOS?”

Responded Bossenmeyer, “I’ll have to get back with you on that
one,” adding that the information would be available on the next
Open Door call (March 10).

But in a third comment, Jinright pointed out, “You guys truly
hold the answer to the future of our company, and I take this very
seriously … The problem that I’m running into is we are not
seeing any decrease at all in our warnings.”

His physicians, he said, “don’t understand what is being asked
of them and the importance of that. Their question to me is, ‘Will
my claims deny for my Medicare beneficiaries as of April?’ and I
have to say, ‘Honestly, no, but mine will.’”

Added Jinright, “With all due respect, I think every supplier
that’s listening right now has the same concerns.”

One New York provider certainly did.

“Wouldn’t the easiest way to get the physicians to comply with
PECOS be to stop their Medicare payments?” she asked. “I think I
speak for every supplier when I ask that question. You would be
bombarded with applications next week.”

CMS officials on the call also gave updates on:

• Competitive
  bidding. With the covered document review process
  complete, the agency is now evaluating Round 1 bids and, based on
  its current timeline, will announce payments in June and contract
  winners in September, said CMS’ Joel Kaiser.

  Responding to a question about the number of bids CMS had
  received and whether there were enough, Kaiser said “it will be
  some time before we identify any possible areas where there is an
  insufficient number of bids to meet our projected demand.”

  As for Round 2, Kaiser reminded listeners the products to be
  included would be “at the agency and department’s discretion.”

• The PAOC. The next meeting of the Program
  Advisory and Oversight Committee is scheduled Feb. 23 at CMS
  headquarters in Baltimore. The all-day meeting is open to the
  public, and information will be posted soon on how to register.

To hear a replay of the call, dial 800/642-1687 and use
Conference ID 45247192. The recording expires today (Jan. 25).