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CMS Delays Medicare’s PECOS Claim Edit Deadline

(December 1, 2009)

Responding to a chorus of concerns, on November 23 the Centers for Medicare & Medicaid Services (CMS) delayed its plans to deny suppliers' claims until April 5, 2010.  NHIA and other provider groups wrote CMS to express alarm about the agency's announced plan to reject 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.)

After first speaking up at a CMS Open Door Forum on October 21, NHIA followed up with written comments on November 12 that included: To prevent a potential claim denial disaster for suppliers, certainly months (not weeks) are needed to educate and prompt physicians to enroll after these CMS steps are completed. The January 4, 2010 deadline needs to be extended considerably. Suppliers should not be put into a panic mode in December by delay of an announcement until just prior to January 4 of a deadline extension.

Several days later, the American Medical Association joined 56 other professional groups in writing CMS to call for an indefinite suspension of the planned claim rejections. Their letter documents that more than 200,000 physicians, or 30 percent of all Medicare physicians, may not be enrolled in PECOS, and goes on to state that Medicare enrollment is widely regarded by the physician community as extremely burdensome.