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.
CMS recently issued Transmittal 327, which sets forth new and tougher signature requirements for medical records. The transmittal and the specific examples of acceptable and unacceptable signatures can be found at: www.cms.gov/transmittals/downloads/R327PI.pdf.
The Department of Health Services’ Division of Quality Assurance released guidance today for health care providers. Specifically, the DQA issued a Quarterly Information Update which, among other things, noted that the Division is not considered a business associate of any health care provider licensed, surveyed or otherwise regulated by DQA. Click here to access this update. The DQA also released frequently asked questions for health care providers. These FAQ’s include helpful interpretation of rules and regulations governing orders, H&Ps, mid-level supervision, etc. These FAQ’s can be found here.
CMS has announced that it will delay enforcement or evaluation of the physician supervision requirements for therapeutic services provided to outpatients of Critical Access Hospitals for the duration of the 2010 calendar year. These requirements, initially set forth in its 2010 OPPS Final Rule, involve “direct supervision” over therapeutic services furnished in hospital outpatient departments and are difficult for many CAHs to meet. CMS plans to revisit the issue of supervision of therapeutic services provided to hospital outpatients in CAHs through the annual rulemaking cycle for CY 2011.
The U.S. Department of Justice’s office in the Western District of New York is reviewing potentially medically unnecessary inpatient admissions for chest pain. The issue initially was identified by the ZPIC for New York state and referred to the MAC. The DOJ is basing its investigation on results of the MAC audits, including unnecessary admissions identified by the MAC for which hospitals have returned overpayments. It also is investigating errors identified by the Recovery Audit Contractor to determine if specific claims rise to the level of fraud.
For now, this investigation is limited to chest pain admissions in 2008 at 24 New York hospitals, although it could become a more in-depth collaboration between the DOJ and program-integrity contractors. Remember – this is the same DOJ office that coordinated the national kyphoplasty investigation.
The Joint Commission recently issued a Sentinel Event Alert on maternal death, which includes specific prevention measures for hospitals health care providers. Download the alert on maternal death.
The U.S. Attorney recently settled its case against the former owners of a Los Angeles Medical Center. The former executives have agreed to pay over $10 million for paying kickbacks to recruiters to bring homeless people to the hospital facility for unnecessary medical services. View the U.S. Attorney’s statement related to this case.
The Department of Health Services’ Division of Quality Assurance recently issued its November/December 2009 Pharmacy Capsule, which included recommendations regarding the faxing of prescription orders. Specifically, the DQA advises that, for controlled substances in schedule III, IV and V, a pharmacy can accept a faxed prescription as long as the fax prescription contains the requisite prescription components. For controlled substances in Schedule II, a prescription only may be faxed for nursing home residents and hospice patients, and only if the fax contains the requisite prescription components. With regard to hospice and nursing home orders, it is important to note that the fax may only be transmitted by the practitioner or the practitioner’s agent; recent DEA activity and interpretation indicates that nurses at nursing homes and/or hospices are not always practitioner agents. Read the November/December 2009 Pharmacy Capsule here.
Beginning December 17, 2009, The Joint Commission has posted MS.01.01.01 (formerly MS.1.20) for field review. The field review will last six weeks, and the proposed standard is identical to the standard drafted in March 2009 with the help of the AHA, AMA and others. To view the standard and other related TJC information, click here.
In response to comments from RACs, providers/suppliers and various health care associations, CMS has modified its limit for document requests from the RAC program for FY 2010. To view this modification, see http://www.cms.hhs.gov/RAC/Downloads/DRGvalidationADRlimitforFY2010.pdf.
