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CMS Responds to Alarm Over Its Plan to Edit Claims Against “PECOS”

(November 5, 2009)

NHIA and others are communicating to the Centers for Medicare & Medicaid Services (CMS) with questions and concerns over the agency's plans to deny suppliers’ claims starting January 4, 2010 which contain ordering or referring practitioners, e.g. physicians, not found on a Medicare database called PECOS (Medicare's Provider Enrollment, Chain and Ownership System.)

Beginning October 5, home infusion pharmacies and other Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers began receiving many warning messages from electronic claims they submit to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) that ordering or referring physicians are not authorized.  One of the causes is for practitioners enrolled in PECOS but the individual National Provider Identifier was not entered on PECOS.

CMS has moved quickly to communicate plans to address many of the implementation issues that became apparent in its roll out of the PECOS claims edit.

The DME MACs have issued a detailed announcement addressing the actions that CMS will take.  This announcement:

  • Provides background explaining what is being done and why.
  • Lists actions CMS will take to ease the burden to suppliers.
  • Advises suppliers on what actions they should take
  • Directs physicians and other practitioners on their responsibilities to complete or update their enrollment in Medicare.

While NHIA is encouraged that CMS has announced actions it will take, we will continue to communicate with CMS regarding concerns that we still have.

NHIA members: click here to learn more.