[Cuda]

Dear Member of Congress,
Medicare beneficiaries will be turned away from home health care, lab work,
medical equipment and other services effective July 6th, 2010 as a result of the
Health Care Reform Bill.
Last fall CMS (Center for Medicare/Medicaid Services) informed medical equipment
suppliers that beginning January 4th, 2011 any claim submitted on which the
ordering physician was not enrolled in CMS’s online PECOS system would be denied.
CMS also informed the suppliers of their responsibility to educate the physician
community to get enrolled in the PECOS system. During the period from the
initial announcement until the January, 2011 deadline, claims would be paid and
would have warning message that the ordering physician was not in the PECOS
system.
In May, 2010 CMS indicated it had issued an interim formal ruling that now makes
the effective date of PECOS compliant claims July 6th, 2010. Even though the
system edits are not yet in place, CMS now states that if they do pay a non-
compliant claim, they will recoup the funds later next year. Additionally, any
supplier that knowingly submits non-compliant claims between now and January,
2011 will be held accountable under the False Claim Act.
Once again, CMS has pushed out a policy before it is ready to be implemented.
1.) There is no incentive for the physician to enroll in PECOS, he/she will
continue be paid on their Medicare claims. However, ancillary providers that
provide services using an ordering physician who is NOT enrolled in the PECOS
system will NOT be paid.
2.) The online PECOS system has been described by physicians as abysmal at
best. One physician spent months trying to complete his application and he
stated “Just when you think you have everything, they ask another archaic
question. Next, they’ll ask if the sky is blue.”
3.) It takes 60-90 days for CMS’s contractor to process the application once
it is submitted.
4.) Over one third of all physicians required to be enrolled in PECOS are not
enrolled.
What affect will this have on Medicare Beneficiaries?
Beginning July 6th, 2010 home healthcare providers, medical equipment suppliers,
imaging, laboratory and specialist services will all begin to turn beneficiaries
away and not provide the orders from any physician who is not enrolled in the
PECOS system. This means critical lab work will be denied, home health care
services will cease, medical equipment suppliers will not provide ordered medical
equipment. Oxygen providers will have to pick up their oxygen concentrators.
Medical equipment providers will have to pick up hospital beds and wheel chairs.
Tens of thousands of Medicare beneficiaries will be left stranded without
services and equipment.
The AMA requested that CMS change this implementation date because they felt it
was too soon, but that fell on deaf ears. We understand the need for PECOS but
the implementation is failing miserably and Medicare beneficiaries will suffer as
the result.
WHEN WE DENY THE BENEFICIARY SERVICES BECAUSE OF THIS, WE WILL BE TELLING THEM TO
CONTACT YOU BEGINNING JULY 6TH, 2010. THIS IS JUST AROUND THE CORNER.

[Regina]

Thanks! I have adapted your letter and sent to my congressmen. This is really making me angry. We spend so much time on BS like this, we barely have time to work on other things, like, oh, servicing patients and getting paid for it.

[Cuda]

UPDATE! I just spoke to Walt Gorski at AAHOMECARE. He is in touch with CMS's PECOS people several time daily. According to him, we will not have to be concerned about existing rentals that were placed prior to 07/06/10. However, I reread the Final Interim Rule and cannot find anything that supports that in the Rule. I have also been told by all 4 DME MACS that we cannot use an ABN because the reason would not be a "medical necessity" reason for denial. Mr. Gorski feels that we can use an ABN. I don't know about the rest of you, but during these time I walk on eggshells when it comes to CMS and until I see it in writing from CMS I will not believe it. We are the ones who have to defend ourselves in an audit and what an outside organization states will not support us on an audit. Remember when Pride put all the fill in the blank forms on their web site for face to face examinations? How many suppliers got in trouble over that?

[Brazzell Marketing]

Here's an article that shows you how to find your congress people including their official email addresses. It also shows you how to find the approved list of PECOS enrolled doctors and the best way to search it - along with practical advice for providers dealing with this crazy rule.

New Medicare Rule Could Cut Your Business by 40% | BMA ADVisor