I'm not sure what's going on with the information below from CMS, which was released on June 30th, from the Office of Public Affairs at CMS. I just received my copy today.
Feel free to read CMS's entire article below in blue - but bottom line - looks like CMS will NOT deny claims from ordering and referring providers and will send out information once they decide how they are going to tackle this problem
The information below is a bit confusing - when I inquired to CMS, the response was they are trying to address many issues with PECOS with regards to who's "in" and who's "not in" - there seems to be many problems with the PECOS list and the claims system with records to the providers who are supposed to be in PECOS and those who maybe or are in, but not on the "list". The "list" being the one published on the CMS website.
EVERYONE IS REMINDED AGAIN - DON'T WAIT!!!
MAKE SURE YOUR PROVIDERS ARE ENROLLED IN PECOS,
IF NOT, COMPLETE THE PAPERWORK NOW!!
CMS TO REVIEW PECOS ENROLLMENT PROCESS
Medicare working with ordering and referring provers and suppliers
to streamline enrollment process
The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chair and Ownership System (PECOS) to ensure that Medicare beneficiaries continue to receive the health care services and items they need. PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.
As part of those efforts, CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010. While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems. CMS is continuing to update and streamline the process, and more providers have been enrolled in the past few days.
CMS issued an interim final regulation on May 5, 2010 implementing provisions of the Affordable Care Act that permit only a Medicare enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) , and certain items and services under Medicare Part B. The new law applies to orders, referrals and certifications made on or after July 1. The comment period for the regulation closes on July 6, after which the comments will be reviewed and considered before a final regulation is issued.
The Affordable Care Act provisions and the regulation were designed as steps to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.
Many physicians and other providers and suppliers have continued to make good faith efforts to comply with the requirements of the law and regulation. These efforts will be a significant factor in determining the procedures and processes that will be incorporated in the final rule.
While the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS. However, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid.
Additionally, though CMS is taking a more deliberative approach to using the PECOS enrollment system, the agency will employ a contingency plan to meet the ACA requirement that written orders and certifications are only issued by eligible professionals effective July 1.
CMS will continue to send informational notices to providers reminding them of the need to submit or update their enrollment and will work with the provider community to provide guidance on enrollment and will process all applications expeditiously.
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