PECOS Enrollment for Referring Physicians Delayed
The Centers for Medicare and Medicaid Services (CMS) announced through a listserv message that the Medicare enrollment requirement for referring or ordering physicians is delayed until April 5, 2010. This rule requires ordering or referring physicians to enroll in the Medicare program by registering in the Provider Enrollment Chain and Ownership System (PECOS), which was initially planned to be implemented on December 31, 2009. CMS believes that the delay would provide enough time for providers to enroll or establish current enrollment records in the PECOS.
Medicare claims will be marked for nonpayment because physicians and other health care practitioners ordering or referring services are not enrolled in Medicare, which poses the risk of reimbursement interruption for legitimate providers. For example, if an ordering or referring physician is not in the CMS PECOS database then the radiologist who furnishes the ordered service will not be paid for their service.
CMS noted that further guidance will be provided addressing many different circumstances such as issues involving enrollment requirements of providers who occasionally order or refer services for Medicare beneficiaries, for instance, dentists and pediatricians. CMS also stated that they will be issuing MLN article to further educate providers about the enrollment requirement.
