Medicare This Week: June 8th, 2012, 4010 Ends July 1st, ePrescribing Hardship Exemptions, Improvements to PECOS
Effective July 1, 2012 only ASC X12 Version 5010 (Version 5010) or NCPDP Telecom D.0 (NCPDP D.0) formats will be accepted by Medicare Fee-For-Service (FFS). Providers that are still conducting one or more of the Version 4010 transactions electronically, such as submitting a claim or checking claim status, or rely on a software vendor, billing service or clearinghouse to do this on their behalf, are affected by this change. Now is the time to contact your software vendor, billing service or clearinghouse, when applicable, if you have not done so already to ensure you are ready. Transactions conducted by Medicare Administrative Contractor (MAC), fiscal intermediary (FI) or carrier telephone interactive voice response (IVR) systems, Direct Data Entry (DDE) and Internet Portals, for those contractors with Internet Portals, are not impacted.
Video: CMS MEDICARE AND PECOS PROVIDER ENROLLMENT .wmv
Important “PECOS” Update…
In 2010, Congress required the use of national provider identifiers for ordering and referring physicians on claims for medical equipment or services from laboratories, imaging providers and suppliers. CMS later issued an interim regulation requiring all physicians who order supplies or refer services, including those from specialists, to be enrolled in PECOS by July 2010, but CMS delayed enforcement of that rule as the agency worked to validate and update enrollment records. Enforcement would have meant that claims for items or services would be rejected unless the ordering or referring physician also was in the enrollment system, not just the physician who provided the care.
CMS Releases Updated Information about PECOS
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Optical News from OpticalCEUs: CMS Updates PECOS
The U.S. Centers for Medicare & Medicaid Services (CMS) said new technical upgrades will make the Internet-based Medicare Provider Enrollment, Chain, and Ownership System (PECOS) easier for health care practitioners to use, reports the American Optometric Association. Read more.
Improvements to the Medicare Internet
Users will soon be able to see if their revalidation application has been received and processed by the Medicare Administrative Contractor (MAC). In addition to a “Revalidation Notice Sent” date, a “Revalidation Received” date and a “Revalidation Complete” date will be displayed on the My Enrollments page. The “Revalidation Notice Sent” date and the “Revalidation Received” date will display on the My Enrollment page for 120 days. The “Revalidation Complete” date will display on the My Enrollments page indefinitely. There are some problems with this system as it has been reported that some physicians are appearing on the page as having been sent a revalidation notice but there is no record of the notice being sent by the Contractor. CMS is aware of this problem and they are investigating it we will notify you when they have discovered the cause of the problem and possible solutions.
CMS Responds to Inquiry on HHA PECOS Status
In its final question, NAHC asked whether, once initiated, the edits would be applied to the date an episode starts (i.e. any episodes that start on or after the activation date) or be applied to all RAP and claims submitted to Medicare on or after the edit activation date. In its response, CMS stated that: “We will not be retroactively denying claims. We will deny from the dates of service on or after the implementation of the denial edits.” This response suggests a lack of understanding of home health episode billing which could include visit span dates prior to and after the edits are initiated. NAHC will work with CMS to resolve this concern and share any new information with members.
Coding Ahead: BASICS OF MEDICARE PROVIDER
This fact sheet is designed to provide education on how physicians and non-physician practitioners should enroll in the Medicare Program and maintain their enrollment information using Internet-based PECOS. It includes information on how to complete an enrollment application using Internet-based PECOS and a list of frequently asked questions and resources.
CMS Posts Medicare Learning Network Enrollment Fact Sheet to Help Educate Ordering Physicians
The Centers for Medicare & Medicaid Services has issued new educational materials for physicians and other ordering and referring practitioners. This fact sheet provides education on the enrollment requirements for eligible ordering/referring providers. In the fact sheet CMS spells out who the requirements apply to as follows:
New PECOS Improvements Prior to Phase 2 of Ordering/Referring
Diamond Level Platinum Level Gold Level rmsource, Inc. Wells Fargo Insurance Services Silver Level Ford & Harrison Medical Protective SunTrust United HealthCare Group Bronze Level Allscripts Apex Technology Bactes Imaging Solution Biz Technology Solutions, Inc. Call-A-Nurse ChoiceHealth, Inc. CNP Technologies Computer Service Partners Coverys DataMax Eastman Kodak Company Fifth Third Bank Healthcare First Citizens Bank Gateway EDI GMK Associates, Inc. Gordon Asset Management, LLC Greenway Medical Technologies, Inc. Henry Schein Medical Humana, Inc. JBA Benefits (Allergy Services, LLC) LabCorp Management Services On-Call Marketing Works McNeary, Inc. Medicus Insurance Company MedLinks Transcription, Inc. MedWaste Solutions NCHA Strategic Partners One Source Document Solutions ONLINE Information Services Physician Discoveries Physicians’ Alliance of America Prince Parker & Associates Professional Recovery Consultants Solstas Lab Partners Stanley Benefits Stern & Associates The Doctors Company TriMed Technologies Corp Virtual OfficeWare, Inc./GE Healthcare