Effective July 6, 2010, physicians who have not enrolled in PECOS or opted out of Medicare will not be able to order or refer Medicare patients for home health services or DME. PECOS is the electronic database of Medicare providers and suppliers. If a physician did not file an 855I enrollment form since November 2003, it is likely that the physician is not enrolled in PECOS. Having an NPI does not mean that the physician is enrolled in PECOS.
The National Association for Home Care and Hospice recently issued a reminder of this new restriction, and noted that physicians should be receiving a letter from his/her Medicare contractor regarding this new requirement in a few weeks. However, the enrollment process is not quick, so physicians who are not now enrolled in PECOS should submit the relevant enrollment applications as soon as possible.
- To determine if a physician is enrolled in PECOS or as an opt-out physician, check the Medicare Ordering/Referring database. If the physician filed an 855I after November 2003, but is not in this database, follow-up with the physician’s Medicare enrollment contractor. Click here for a list of contacts.
- If you need to submit an enrollment application, follow the directions on the CMS website. If you want to enroll electronically, follow the directions for Internet-based PECOS. You will need to register before you use the electronic enrollment.
- If a physician wants to reassign his or her right to bill Medicare and receive payments, he or she must enroll first on the 855I, and then file an 855R for the reassignment.
Background: This new Medicare requirement implements a provision in Health Reform, and is contained in a Medicare Interim Final Rule at http://frwebgate4.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=014643292835+0+2+0&WAISaction=retrieve The comment period is open until July 6, 2010, if you want to comment on the proposed rule.