Medicare PECOS Policy Changes Delayed Until April 2010

On October 5, 2009, the Center for Medicare and Medicaid Services (CMS) began implementing the first phase of a new policy under Medicare which would not pay claims for services when the referring or ordering physician or health care practitioner is not in the Provider Enrollment, Chain and Ownership System (PECOS) database. CMS announced the policy in Change Requests 6417 and 6421.

Hundreds of thousands of otherwise acceptable Medicare claims had been marked for non-payment merely because providers ordering or referring an item or service were enrolled in the Medicare program prior to 2003 when the PECOS database was developed. CMS had planned to begin rejecting these and other claims where the referring or ordering physician was not showing in the PECOS database on January 4, 2010.

The Heart Rhythm Society, along with the American Medical Association and several other medical societies, sent a letter to CMS urging the agency to withdraw the policy until concerns about referring or ordering physicians and other health care practitioners has been addressed. As a result, CMS announced that it would postpone implementation of the policy until April 5, 2010.

The delay in implementing the policy will give providers who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers sufficient time to enroll in Medicare or take the necessary actions to establish a current enrollment record in Medicare prior to implementation.

Heart Rhythm Society members who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003 are encouraged to update their enrollment record now to establish a current file in PECOS.

Information on how to enroll in Medicare is found on the Medicare provider/supplier enrollment website: www.cms.hhs.gov/MedicareProviderSupEnroll.