CMS Announces PECOS Deadline to be Pushed Up to July 2010

On May 5, 2010, the Center for Medicare and Medicaid Services (CMS) published an Interim Final Rule in the Federal Register which pushed up the deadline for all Medicare-participating providers to be enrolled in Medicare through the Provider Enrollment, Chain and Ownership System (PECOS).  Under the new rule, all physicians who order or refer imaging, laboratory and specialist services must be enrolled through PECOS by July 6, 2010.

The new enrollment deadline for Medicare providers is six months sooner than expected, as the previous deadline had previously been postponed until January 3, 2011.   The previous April 5, 2010 deadline had been pushed back in mid-February at the request of the American Medical Association and other physicians’ organizations.  However, CMS said that a new mandate from the health system reform law forced the deadline change.

Many Physicians’ Organizations Opposed to New Rule

The AMA and numerous other physicians’ organizations have argued that the new CMS rule goes beyond what is required by the Affordable Care Act.  Under that legislation, only physicians who order and refer durable medical equipment (DME), prosthetics, orthotics and supplies (POS) or home health services are required to be enrolled with Medicare through PECOS by July 1, 2010.  The CMS rule goes a step further, however, by requiring that all doctors who order or refer imaging, laboratory and specialist services also be enrolled through PECOS by July 6, 2010.

Accordingly, many physicians’ organizations have urged CMS to revert to the January 3, 2011 deadline for those providers ordering and referring services other than DME, POS and home health services.  If the deadline is not pushed back, it has the potential to interrupt Medicare cash flow for many providers through no fault of their own.  If a physician submits a Medicare claim after the July 6th deadline that lists the name of a referring or ordering physician who is not enrolled in PECOS, the claim might be rejected.

CMS Provide Guide to Facilitate Enrollment

To help Medicare physicians through the process of enrollment, CMS has developed a step-by-step guide that is available through the Members Only portion of the CMS website.  Physicians have also been advised by CMS to check to make sure that their names are listed on the list of PECOS-enrolled providers on the CMS website.