Relief—and still some concern—is being expressed over a decision to postpone until April 5 the implementation of a new CMS policy to not pay claims for services when the referring physician is not in the CMS enrollment database.
Relief mixes with concern about CMS claims policy
The Marshfield (Wis.) Clinic and 55 medical societies had signed onto a letter circulated by American Medical Association protesting the policy and noting how its “quietly announced” Jan. 4, 2010 implementation date was causing “considerable confusion, even panic” because it could affect as many as 200,000 of the more than 793,000 physicians and other healthcare providers who enrolled in Medicare before the database known as the Provider Enrollment, Chain and Ownership System, or PECOS, was developed some six years ago.
According to Donna Andrew, the Marshfield Clinic’s director of patient financial services, it is still a work in progress. She said if a different form of a physician’s name is used on the claim—such as a shortened first name or if a middle initial is used—than appears in the PECOS database, the claim could be denied. Andrew said the new policy has led to Marshfield cross-checking to make sure that the names of its 800 physicians and the names of the multitude of doctors in its referral base match the name stored in PECOS.
“We were struggling for the last two weeks with how we would be able to do this by Jan. 4,” she said.
In an e-mailed statement attributed to its president, J. James Rohack, M.D., the AMA noted that it still had concerns.
“The extension from January to April is helpful as it will provide more time to conduct the necessary outreach to physicians to alert them to this new policy,” the e-mail said. “The AMA remains concerned however that this remains an insufficient amount of time to get all the physicians into PECOS who need to re-enroll, ensure that all Medicare contractors are able to adequately absorb this new work, prevent enrollment backlogs, and avoid claims processing interruptions."
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