Thursday, July 1, 2010

CMS Delaying Rejection of Providers Not Enrolled in PECOS

The Centers for Medicare & Medicaid Services (CMS) has announced that they will not enforce the automatic rejection of claims from providers not enrolled in the Provider Enrollment, Chain, and Ownership System (PECOS) until January 3, 2011.

By July 6, 2010, physicians who order or refer for covered Part B services must revalidate their enrollment in PECOS online. Several providers have reported issues in completing the application and revalidation process and called on CMS to delay the rule until problems with the system were worked out. This rule will still be effective by July 6; only the automatic rejection of claims will be delayed until January 2011.

Many hospitals are putting the responsibility on MSPs responsible for credentialing to verify enrollment in Medicare as part of the initial credentialing process. NAMSS will monitor this carefully during the next year. Best practice credentialing procedures include MSPs reviewing the OIG and/or the Medicare/Medicaid Exclusion List. Enforcement guidelines for the PECOS database will likely be developed over the remainder of the year.

Source: BNA

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