CMS Changes PECOS Implementation Date Again - to July 6, 2010
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CMS Changes PECOS Implementation Date Again – to July 6, 2010

The Centers for Medicare and Medicaid Services (CMS) recently published an interim final rule that is a requirement of the Patient Protection and Affordable Care Act (PPACA) passed in March.  The interim final rule moves the date that referring physicians must be enrolled in the Provider Enrollment Chain and Ownership System (PECOS) from January 3, 2011 to July 6, 2010 – six months earlier than previously announced.

DMEPOS suppliers who take Medicare referrals on or after July 6 from referring physicians who are not enrolled in PECOS risk having those claims rejected, according to CMS.

CMS is currently implementing system edits to detect if an ordering and referring physician is enrolled in PECOS. The edits may not be in place by the July 6 deadline, but CMS indicated that it reserves the right to go back and reprocess claims.  When CMS implements edits to the system, if the correct name and National Provider Identifier (NPI) combination on the claim for the ordering and referring physician is not enrolled in PECOS, the claim will be rejected.  CMS will give providers advance notice of when the edits will be in place.

To determine if a physician is enrolled in PECOS, visit CMS's Medicare Provider-Supplier Enrollment Web page at http://www.cms.gov/MedicareProviderSupEnroll.  To get a list of eligible physicians, click on the Ordering Referring Report on the left-hand side of the page and scroll down to the downloadable file.

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