The Centers for Medicare and Medicaid Services (CMS) has published an interim final rule that changes the date by which referring physicians must have active accounts in the Provider Enrollment Chain and Ownership System (PECOS) from Jan. 3, 2011 back to July 6, 2010. According to Jim Bossenmeyer from CMS, the earlier implementation date is a requirement of provisions contained in the Patient Protection and Affordable Care Act (PPACA) passed earlier this year. In order for a physician or other qualified healthcare practitioner referral or order to be considered valid for Medicare claim submission purposes, it must come from a provider with a current PECOS enrollment record. Originally scheduled for implementation on Jan. 4, 2010, the PECOS requirement has been delayed several times in order for CMS to develop proper system edits to properly enforce it. While Bossenmeyer stated in a May 26, 2010 CMS Open Door Forum that PECOS system edits may not be fully functional by July 6, 2010, CMS reserves the right to reprocess claims that should not have been paid due to an invalid referral once the edits are fully functional. The four DME MACs are continuing to generate warning notices when services are referred by physicians who do not have a current PECOS record. It is important to continue to remind your referral sources that in order to continue to refer Medicare beneficiaries for services, they must be enrolled in PECOS by July 6, 2010.
For more information, please review the Federal Register, Page 24442 for the full text. The enabling language is in the third column of that page.
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You must refer to file code CMS–6010–IFC.
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