CMS Will Not Automatically Reject Claims on July 6

CMS is working with providers to review and streamline the Provider Enrollment, Chain and Ownership System (PECOS) enrollment process, according to a press release. To ensure that Medicare beneficiaries continue to receive health care items and services they need, CMS will not implement changes that would automatically reject claims based on prescriptions from referring physicians who have yet to enroll in PECOS by July 6.

Although more than 800,000 physicians and health care professionals have approved applications in the PECOS system, many physicians have encountered problems with their enrollment.

“This is a good thing because it will give Medicare more time to correct the software issues they had with their physician registry,” Kathy Dodson, senior director of government affairs for American Orthotic and Prosthetic Association (AOPA), told O&P Business News. “And it will give physicians even more time to enroll.”

The regulation will be effective July 6, however, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims. They will continue to be reviewed and paid as they have historically been reviewed and paid. CMS will continue to send informational notices to providers reminding them of the need to submit or update their enrollment.

CMS originally published an interim final rule that changed the implementation date of PECOS from January 2011 to July 6, citing provisions contained in the Affordable Care Act passed earlier this year. The Affordable Care Act was designed to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers could order and refer covered items and services to Medicare beneficiaries.

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