CMS has provided its required 60 day notice that beginning May 1, 2013, it will begin denying home health claims where services and supplies are ordered/referred by physicians not enrolled in PECOS. PECOS is the Provider Enrollment, Chain, and Ownership System where ordering/referring physicians establish their Medicare enrollment record and identify their specialty.
In the transmittal, CMS points out that Home Health Agency (HHA) services may only be ordered or referred by a Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or Doctor of Podiatric Medicine (DPM). Claims for HHA services ordered by any other practitioner specialty will be denied.
Sansio encourages all of its customers to review their utilization of integrated PECOS enrollment checking functionality which appears in several HomeSolutions.NET areas including Intake/Referral, Physician Info, the patient’s Virtual Chart, PECOS Dashboards and Reports.
PECOS was originally intended to go into effect in 2010, and Sansio released integrated PECOS checking functionality ahead of this initial deadline.