For background on this article, read: New Medicare Rule Could Cut Your Business by 40%
CMS issued a press release with the information below. Many home health agencies and home medical equipment (HME) companies will read this and think, “crisis averted.” Not so fast. CMS has reversed its decision to drop a bomb on home health and HME, and subtly threatened instead to plant land mines. In their release, CMS states they will not automatically reject claims based on PECOS non-enrollment in the near future. However, they also state, “the regulation will be effective July 6, 2010,” and “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.” In other words, CMS is leaving the door open to demand repayment of claims based on orders from physicians not enrolled in PECOS. Did you think RAC audits were a scary proposition before? Try an RAC audit with 24% to 40% of your doctors not being allowed to sign your orders.
This press release shows that CMS has clearly paid attention to public comment on the interim final rule. We must keep the pressure on. We must insist that CMS remove all unclear threats from its language. CMS should only implement this rule with 120 days notice to HME and home health providers. This notice must have a clear deadline. To do otherwise would put honest businesses at and unfair disadvantage as well as jeopardize the continuity of care for tens of thousands of vulnerable, elderly patients. Communicate with your national and state associations to tell them you want them to keep the pressure on. Contact your federal legislators to tell them that unclear threats from CMS are bad for the industry and bad for patients.
How to contact your legislators:
- Go to www.VoteSmart.ORG.
- Enter your zip code at the top left of the page.
- Find a list of your congressional representatives.
- Click each representative.
- Their contact information will appear at the bottom right.
- Call each office or click through to each congress person’s website.
- Advise your policy makers that promising to not automatically reject claims while reserving the right to demand repayment in the future only complicates matters. Because home health bills in 60 day episodes, we need a clear implementation date with at least 120 days notice.
CMS TO REVIEW PECOS ENROLLMENT PROCESS
Medicare Working with Ordering and Referring Providers 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, Chain 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.
Pretty insightful post. Never thought that it was this simple after all. I had spent a good deal of my time looking for someone to explain this subject clearly and you’re the only one that ever did that. Kudos to you! Keep it up
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