News and Updates

PECOS Enforcement Dates Moved Up to July 6, 2010 But Much Remains Unclear

(June 1, 2010)

Section 6405(a) of the Affordable Care Act (health reform bill) specifies for suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) that payment may be made only if the written order for the item has been placed by a physician or other eligible professional who is enrolled in Medicare. Section 1128J(e) requires that the professional be identified by legal name and NPI in the claim submitted by the supplier. The statutory effective date for both provisions is July 1, 2010.

In its Interim Final Rule CMS-6010-IFC published May 5, 2010, the Centers for Medicare & Medicaid Services (CMS) set the effective date regarding the ordering and referring provisions of the Act as July 6, 2010.  Home health agencies must also conform to these requirements.

On its May 25, 2010 Open Door Forum, CMS said for written orders made prior to July 1, 2010, suppliers should submit these claims as soon after the order is written as possible. CMS is authorized to conduct administrative reviews for suppliers' claims that are not in compliance on or after July 6. CMS made clear that while the interim final rule is in the comment period, it is effective until a final version of the rule is published.

CMS indicated that they would not begin rejecting claims through front-end electronic submission edits on July 6 but would not give a date.  (The previously announced date for the edits had been January 3, 2011.)  However, the agency was unclear on exactly how it will deal with non-compliance after July 6.  It appears CMS is still working out details and will notify the public when they have everything figured out -- no timeline was given. CMS encouraged the audience to submit comments in this area to CMS-6010-IFC which are due by July 6.