"Medicare Update"

Pathologists Not Enrolled In PECOS By July 6 Risk Denial of Medicare Claims

JULY 6, 2010, IS THE NEW DEADLINE for pathologists to enroll in the Provider Enrollment, Chain and Ownership System (PECOS) or risk being denied payment for Medicare claims.

The federal Centers for Medicare & Medicaid Services (CMS) recently issued a statement that it will not pay physicians and their referring providers if they fail to enroll in PECOS. In response to this news, Pathology Service Associates, LLC (PSA), sent a notice to its client pathologists last week recommending that they act in a timely fashion to complete their enrollment in PECOS.

PSA said that the July 6 deadline is new. Before announcing the new deadline last week, CMS had set the PECOS enrollment date as January 3, 2011.

Payments in Question

“CMS has refused to clarify whether or not they would continue to pay claims for physicians if both the physician and referring provider are not enrolled in PECOS by July 6, 2010,” PSA said. “Therefore, PSA will continue to monitor the status of PSA client enrollment with CMS and encourages our clients to continue contacting their referring physicians regarding enrollment.”

Significantly, pathologists and all physicians should recognize that enrollment in PECOS is a separate process from enrolling in traditional Medicare. Although they are likely in the Medicare system, PSA believes many physicians are not yet enrolled in PECOS.

PSA’s own statistics bear this out. It reports that only 55% of its affiliated pathologists are currently enrolled in PECOS. It says the number is that high, in part because PSA has assisted its affiliated pathologists in submitting to Medicare the required PECOS enrollment forms.

“As of June 1, 57% of these enrollments have been processed by CMS,” PSA said. The carriers that process the enrollment forms, however, have informed PSA that there is a backlog in enrollment packages over the past few months. This is causing a delay in the processing of some pathologists’ enrollment forms and pushed them back from 60 days to 90 days. “PSA will continue to keep our clients updated on their enrollment status,” PSA said.

The surprise that awaits many pathologists is the fact that they need to ensure that all their referring physicians are also enrolled in PECOS. Recognizing this fact, PSA advised that “Due to this uncertain deadline and backlog in enrollment processing, PSA encourages our clients to contact their referring physicians immediately regarding enrollment. At present, claims for PSA billing clients are being processed normally but we have begun receiving warning messages from some Medicare carriers indicating that many of our client’s referring physicians are not enrolled in PECOS or otherwise not found in the carrier’s claim systems.”

According to this new Medicare rule, physicians who order and refer durable medical equipment, prosthetics, orthotics and supplies, or home health services are required to be enrolled with Medicare through PECOS by July 1. But CMS also is requiring that doctors who order or refer imaging, laboratory, and specialist services must be enrolled by July 6, according to AM News.

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