CMS Pushes Date By Which All Physicians Who Refer or Order Must be Enrolled in PECOS to January 3, 2011

October 22, 2010

CMS has decided not to reject any claims based on orders, certifications, and referrals made by providers who have not yet had their application approved beginning July 6, 2010, in favor of the original January 3, 2011, deadline.

Prior to the passage of the new health system reform law, the Centers for Medicare and Medicaid Services (CMS) announced that all physicians/providers who order and refer services to other health care providers must be enrolled by January 3, 2011. The new law required physicians who order and refer DMEPOS and home health to be enrolled by July 2010. The law permits CMS to allow physicians who order or refer other Part B services to be enrolled later; but CMS decided instead to require all physicians to be enrolled in the Provider Enrollment, Chain and Ownership System (PECOS) by July 6, 2010.

Due to the problems physicians have had with enrollment over the past few years and the lack of appropriate contractor resources to handle the volume of enrollment applications, the AAN voiced its objections to CMS concerning the impact this could have on claims processing and the time needed for all referring or ordering physicians to become enrolled. As a result, CMS has decided not to reject any claims based on orders, certifications, and referrals made by providers who have not yet had their application approved beginning July 6, 2010, in favor of the original January 3, 2011, deadline.

In addition, CMS is implementing a contingency plan for those who order or refer DMEPOS or home health that have been working towards enrollment by the deadline but are still not yet enrolled. Physicians who have opted-out of Medicare do not need to be in PECOS. The AAN encourages those that have opted out of Medicare to contact your Medicare contractor to confirm your opt out status.

The AAN urges members to check with their Medicare contractors, the AAN and the American Medical Association (AMA) on any future information associated with this policy as CMS expects to publish a final rule with more details in July.

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