The U.S. Centers for Medicare and Medicaid Services (CMS) has extended the time frame in which physicians can enroll in its Provider Enrollment, Chain, and Ownership System (PECOS), according to the American College of Radiology (ACR).
"CMS believes that the delay would provide enough time for providers to enroll or establish current enrollment records in the PECOS," Reston, VA-based ACR said in a statement. "But the delay also poses the risk of reimbursement interruption for legitimate providers."
In January 2009, CMS made Internet access to PECOS available to physicians in all states, announcing also that any physician who refers or orders tests must enroll in the system for the test to be reimbursed; CMS initially said that Medicare would provide warning messages on claims submitted by unenrolled physicians from October 1, 2009, through January 4, 2010. Now the agency plans to deny claims through April 5 of this year.
The delay is bad for radiologists, according to Pam Kassing, ACR's senior director of health economics and policy.
"Right now only about two-thirds of Medicare's referring and treating physicians are enrolled in PECOS," Kassing said. "So that means that if a radiologist's referring physician isn't enrolled -- and radiologists depend on referrals -- the radiologist won't get paid for performing the study."
For those providers who are already enrolled in the Medicare program, CMS recommends that they check to see that their information in PECOS is current. CMS plans to make the names and national provider identifiers (NPIs) of the Medicare physicians and nonphysician practitioners who are eligible to order or refer in the Medicare program publicly available on the Internet prior to implementing the enrollment requirement, according to the ACR.
Medicare providers can either use the Internet-based PECOS system or fill out a paper enrollment application, CMS said. The agency plans to issue a Medicare Learning Network (MLN) article to further educate providers about the enrollment requirement.
By Kate Madden Yee
AuntMinnie.com staff writer
January 6, 2010
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