Physician Orgs Say July PECOS Deadline is Premature

An interim final rule issued by the Centers for Medicare & Medicaid Services (CMS) requires physicians and other eligible professionals (EPs) who order or refer most types of covered Medicare services and items to have an active record in the Provider Enrollment, Chain, and Ownership System (PECOS) much sooner than expected. A group of medical associations continues to urge CMS to reconsider the recent ruling.

According to the health reform law the Obama administration enacted this year, the American Medical Association (AMA) says, only physicians who order and refer durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) or home health services for Medicare beneficiaries are required to be enrolled with Medicare through PECOS by July 1.

This legislation, however, gives the Secretary of Health and Human Services (HHS) the authority to extend the requirements to other items or services. CMS, according to the interim final rule published May 5 in the Federal Register, also is requiring physicians and EPs who order or refer imaging, laboratory and specialist services to be enrolled in PECOS by July 6.

“Physicians have been operating under the assumption that they had until Jan. 3, 2011,” writes amednews staffer Chris Silva, June 14.

According to the rule, CMS is requiring for “Part B claims for covered services of laboratories, imaging suppliers, and specialists … the ordering or referring supplier be a physician or an eligible professional with an approved enrollment record in PECOS.”

“The AMA and more than 40 other physician organizations contend otherwise, noting in a May 28 letter to CMS that the regulation goes beyond what is called for in the health reform statute,” writes Silva.

CMS says physicians and EPs can avoid this requirement by opting out of Medicare and entering into private contracts with Medicare beneficiaries. However, the process of opting out in fact creates a valid record in PECOS, and physicians and EPs not enrolled in Medicare are still required to include their National Provider Identifier (NPI) in Medicare claims.

For more details, read “Physician Deadline for Medicare PECOS Enrollment Moved Up to July” on amednews.com.

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