Medicare Ruling Puts Home Health Patients at Risk

A provision in the Patient Protection and Affordable Care Act published recently by the Centers for Medicare and Medicaid Services (CMS) states that, as of July 6th, home health agencies will be prohibited from submitting claims for reimbursement from physicians who have not enrolled in a new online system.

Failure to register in the Medicare Provider Enrollment, Chain and Ownership System, or PECOS, would also block these physicians, who can still see Medicare patients, from referring new patients for Medicare-covered home health services.

At issue is that CMS has not adequately educated physicians about this new requirement.  The result is that as many as 50% of physicians in Massachusetts (NAHC estimates 20-40 percent nationally) have not registered on PECOS.  Moreover, the registration and approval process can take several weeks, so even if physicians were to register immediately, their status would not be approved by the July 6 deadline.

HCA, along with the VNA of Boston and other agencies and organizations are urging the Centers for Medicare and Medicaid Services and Congress to delay implementation of the rule until such time as physicians have ample time to enroll and also to hold harmless the home health providers that will suffer from the abrupt transition.

What to do:

• NAHC has provided background in its June 22 newsletter and a message is available in HCA’s Legislative Action Center (SCROLL DOWN UNTIL YOU SEE THE MESSAGE: “DELAY PHYSICIAN ENROLLMENT REQUIREMENT AND HOLD HOME HEALTH AGENCIES HARMLESS”)

• See HCA’s “Notice for Physicians” for home health and home care agencies.

• For more information, see a blurb from the Massachusetts Medical Society’s recent newsletter and the website of the American Medical Association.

Return to www.thinkhomecare.org.