The Centers for Medicare & Medicaid Services plans to work with providers to address concerns about enrollment in Medicare's Provider Enrollment, Chain and Ownership System.
PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.
As part of that effort, CMS will not, for the time being, implement changes that would automatically reject claims based on orders, certifications and referrals made by providers that have not had their applications approved by July 6. While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems.
CMS officials said they are continuing to update and streamline the process, and more providers have been enrolled in the past few days.
CMS issued an interim final regulation on May 5 implementing provisions of the Affordable Care Act that permit only a Medicare-enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) and certain items and services under Medicare Part B.
The new law applies to orders, referrals and certifications made on or after July 1. The comment period for the regulation closes on July 6.
The Affordable Care Act provisions and the regulation were designed to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.
CMS has said it recognizes that many providers and suppliers are making good-faith efforts to comply with the requirements of the law and regulation. The agency says these efforts will be a "significant factor" in determining the procedures and processes that will be incorporated in the final rule.
While the regulation will be effective July 6, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS. Submitted claims will continue to be reviewed and paid as they have historically been, the agency said.
CMS will use a contingency plan to meet the requirement in the reform law that written orders and certifications are only issued by eligible professionals effective July 1. The agency will continue to send informational notices to providers reminding them of the need to submit or update their enrollment.