Orthopedic Coding Alert

Medicare postpones July 6 implementation and works to streamline enrollment process.

You don't have to worry about your PECOS eligibility, at least for the time being. The Centers for Medicare & Medicaid Services (CMS) has delayed the implementation of changes in its Provider Enrollment, Chain and Ownership System (PECOS) that would automatically reject claims based on orders, certifications, and referrals made by providers who have not been approved into the system by July 6.

PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program. Despite more than 800,000 physicians and other health professionals enrolling in PECOS, some providers have encountered problems. This has prompted CMS to postpone the implementation of the automatic rejection policy, while simultaneously updating and streamlining the application process.

Retrospect: CMS issued an interim final regulation on May 5 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 also 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.

According the CMS, "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."

There is some concern that the claims of a PECOS-certified specialist could be delayed if the provider listed as the referring physician on the claim is not a PECOS-certified provider, says Michael Weinstein, MD, a physician in Washington, D.C., and former member of the AMA's CPT Advisory Panel. "Even if you have already completed the online PECOS registration, you should remind your referring physicians to do the same," he adds.