CMS informed AAHomecare yesterday that Phase 2 of the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) will go into effect May 1, 2013. As of that date, CMS will deny home medical equipment (HME), Part B, and Part A home health agency claims that are prescribed by health care professionals who are not enrolled in the PECOS system.
Phase 1 of the PECOS system began on October 5, 2009. At that time, CMS started warning HME providers who were submitting claims ordered by clinicians who were not yet enrolled in PECOS. Due to the extremely high number of warnings that HME providers were receiving, AAHomecare immediately asked CMS to take a much more measured approach and delay the start of Phase 2 until data showed that the vast majority of ordering clinicians were enrolled in the system.
CMS indicates that they have taken proactive steps to enroll ordering and referring providers. By their estimates, less than one percent of ordering clinicians have not enrolled in PECOS. To see if an order is from an enrolled clinician, click here.
HME providers can avoid unnecessary denials by ensuring that they submit claims using the individual clinician NPI rather than the organization NPI.
For a detailed description of PECOS-related issues and activities including an FAQ, read MLN Matters.