[lsologuren]

One thing I have learned is that it is not just DME suppliers that will be affected. It also all Home Health and laboratory services.

[McLeod]

I was told that the Physician's will not be paid if they are not enrolled also. Is there any where I can get this info documented?

[HEATHER]

The physician's claims WILL pay. That is a large reason for the uproar.

Also - I have 3 physicians (out of the first 10 warnings I am looking into)
where my database (first name, last name and NPI #) matches the PECOS
database and the NPI database EXACTLY! I also confirmed that my warning was
given AFTER the date the physician appeared on the PECOS database (warning
6/28 - PECOS last updated 6/24.) Anyone else having this problem?

[DMEisgoodfun]

I've noticed this too. Another reason for CMS not to implement.

[HEATHER]

Here is the thing - everyone w/ a Medicare number has to re-enroll every so
often - HME's are every 2 years, not sure if physicians are the same? So
CMS says "all enrollment/changes must be done thru PECOS as of today,

[AndreaStark]

Originally Posted by HEATHER

Here is the thing - everyone w/ a Medicare number has to re-enroll every so
often - HME's are every 2 years, not sure if physicians are the same? So
CMS says "all enrollment/changes must be done thru PECOS as of today,

It is my understanding that paper CMS-855 forms will still be accepted. If a paper application is submitted, the physician's information will then be uploaded into the PECOS system by the contractor. The online system is just another way of updating thier information and offers a faster processing time than traditional paper applications.

"The Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) can be used in lieu of the Medicare enrollment application (i.e., paper CMS-855)" - CMS.gov.

The thing with physicians, is that CMS didn't begin updating the PECOS system with paper applications until 2003. That means those physicians who enrolled more than 6 years ago and who haven't updated their information since then weren't initally in the system. These physicians can still update their enrollment record by submitting a new paper CMS-855; however, it will supposedly take longer to process than the online enrollment option.

*Michelle

[HEATHER]

I called Cigna to ask about warnings where all data matched PECOS enrollment data - tier 1:

Yeah, there are some glitches in the system - but don't worry - those claims won't deny!

Riiiight. Because she can guarantee me that in 6 months we won't be responsible for all this? Tier 2 please...

Tier 2:

There are some warnings going out by mistake where your data is correct and matches PECOS record.. there are instances where warnings are not being sent when they should be. There is a Listserv message going out to providers today explaining there are problems with the system.

But she couldn't say what that listserv message states.. said it was not the same info that CMS sent out on the 30th. I love how they allow all of us to spend countless hours scrutinizing all this data for all these warnings, contacting physicians, and then say "oh yea, there are problems with that whole system." Not holding my breath for that listserv either.

[Regina]

We sent out letters last week, and have had several doctors' offices call to say that they didn't know about it, and they can't seem to finish their changes on line- they get kicked out before they are done. When they call the phone number provided, they get a recording stating that all lines are busy and get disconnected. This is too much fun! We have already turned down three customers today whose physicians are not in PECOS.

[Brazzell Marketing]

I have yet to find this July 6 statement from CMS, but everything I have read about it makes it sound like a rehash of the press release CMS issued on July 2. You can get that and future press releases straight from the horse's mouth here: Media Release Database Press Releases
Further analysis on that and future press releases here:
BMA ADVisor |

In short, in response to overwhelming complaint and the sudden realization that thousands of patients may loose access to their HME and home oxygen, CMS issued the most recent press releases. They say that they will continue to pay claims as they always have, but the claims certified by non-PECOS docs are still illegal as of July 1 or July 6!!!! CMS was put in a tough spot by recent regulations that wanted to hurry up with some of their plans for PECOS, but that's a weak excuse considering all the pointless and unfair problems they are causing to home medical equipment and home health care providers. At this point, CMS is basically paying all claims as normal to avert a major backlash from health care providers and patients, but they are reserving the right to pick you off one by one in the future. They'll pay you now for claims that they have made illegal, and CMS reserves the right to come get you for false claims at any point in the future - even a couple of years down the road presumably.

This fight is by no means over. HME, home health, and medical associations must keep the pressure on CMS to handle PECOS implementation fairly. Work through your associations, but also go here for a step by step of what you as an individual citizen can do:
BMA ADVisor |

By the way, today marks the end of CMS's open comment period for this rule that doesn't pay HME or sets HME up for paybacks, so get your comments in tonight if you can. More info on how to comment to CMS is in this article:
New Medicare Rule Could Cut Your Business by 40% | BMA ADVisor

[Regina]

Since this ruling comes from CMS, does it affect Medicaid claims as well?