ACR Concerned with PECOS Enrollment
The Centers for Medicare and Medicaid Services (CMS) announced a further delay in the requirement that ordering and referring physicians be enrolled in Medicare’s Provider Enrollment Chain and Ownership System (PECOS). A large percentage of ordering and referring providers are still not aware of this requirement and have not complied; therefore, the April 5, 2010 implementation date was extended until January 3, 2011. As of 2011, Medicare claims will be marked for nonpayment when physicians and other health care practitioners ordering services are not enrolled in Medicare. This poses the risk of reimbursement interruption for legitimate providers who are enrolled. For example, if an ordering physician is not in the CMS PECOS database, then the radiologist who provided the ordered service will not be paid for their work.
The ACR remains very concerned with the ramifications implementation will have on its members and recommends that members contact their referring physicians to ensure they are enrolled by the 2011 deadline to avoid any interruptions in payments. The names and national provider identifier (NPI) numbers of the Medicare physicians and non-physician practitioners who are already enrolled in PECOS are publicly available on the CMS Web site at Eligible Referring/Ordering Physician List.
It is important to note that having an NPI number does not mean you are enrolled in PECOS. Medicare physicians and other providers need to be enrolled in the PECOS system in addition to obtaining an NPI number. Information on how to enroll in the PECOS, can be found on the CMS Web site at www.cms.hhs.gov/MedicareProviderSupEnroll/downloads/GettingStarted.pdf.
This most recent delay in the enrollment of ordering and referring physicians will allow submitted Medicare claims to be monitored, processed and not rejected if the referring and ordering physicians are not enrolled for the remainder of 2010. However, claims from a referring or ordering physicians not enrolled in the PECOS will continue to be marked with an error message until the referring or ordering physician establishes or updates his or her enrollment record in the PECOS.
Again, the ACR strongly urges its members to contact those referring and ordering physicians not on the Eligible Referring/Ordering Physician List and inform them to enroll in the PECOS prior to the January 3, 2011 implementation date.
Please contact Helen Olkaba in the Department of Economics and Health Policy with your questions regarding the PECOS enrollment requirements at holkaba@acr-arrs.org.
For additional information, visit the following CMS Web sites:
Overview of PECOS
www.cms.hhs.gov/MedicareProviderSupEnroll/01_Overview.asp#TopOfPage
Ordering/Referring Report
www.cms.hhs.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp#TopOfPage
Application Submission Options:
www.cms.hhs.gov/MedicareProviderSupEnroll/downloads/GettingStarted.pdf
Click here for a copy of Transmittal 572, which describes the expansion of the current scope of editing for ordering and referring providers for Medicare claims.
