PECOS Delay – Official Announcement

CMS has added  an MLN Matters article about the PECOS delay which was announced earlier this week.  It is titled:  SE1305 – Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856).

NAHC  has posed the following questions to CMS:

  1. Must home health agencies issue a beneficiary notice to patients whose services will be terminated because of failure of their physician to be enrolled in PECOS and, if so, what notice?
  2. May home health agencies hold beneficiaries liable for the cost of care?
  3. Do apostrophes appear in PECOS files and in the edit files that will be used by the MACs (conflicting guidance from CMS to providers about use of apostrophes)
  4. Will claims be edited against the original Phase 2 May 1, 2013 “from” date or will this date be amended?
  5. Would CMS please add the effective date of physician enrollment to the Ordering/Referring File?

The Alliance appreciates NAHC pushing for these answers and will share information as we get it.

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Author: Pat Kelleher

Pat Kelleher is Executive Director of the Home Care Alliance of Massachusetts.

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