New Medicare Rules

New Medicare Rule Could Cut Your Business by 40%
This Rule Takes Effect Next Week.
Act Now to Protect Your Patients and Your Industry.
As of July 6, 2010, up to 40% of doctors who order home health services may no longer be able to do so.  For years, the Centers for Medicare & Medicaid Services have urged doctors to enroll in PECOS (Provider Enrollment Chain and Ownership System).  CMS hasrepeatedly delayed implementation of a rule stating that only doctors enrolled in PECOS can order or refer services for Medicare beneficiaries. Until recently, the latest postponed deadline was January 3, 2011.  However, the Patient Protection and Affordable Care Act signed into law on March 23, 2010 moved the deadline to next week, July 6, 2010.  The National Association for Home Care & Hospice(NAHCH) reviewed home health agency audits and found that 24% to 40% of ordering physicians did not meet the PECOS enrollment requirements.
The PECOS rule will not affect immediately every type of service ordered by a physician.  As of July 6, 2010, CMS will reject claims from DMEPOS providers if those claims show an authorizing physician who is not PECOS enrolled.  DMEPOS providers are durablemedical equipment, prosthetics, orthotics, and supplies.  NAHCH states that home health bills will also be checked against PECOS enrollment starting July 6.  Bills you have already entered may also be affected if they have dates of service on or later than July 6.  Laboratory services, imaging services, and specialist services may also be affected.  The physician’s ability to bill for their ownservices and to order Part B drugs may not be affected until 2011.
When a doctor enrolls in PECOS, it typically takes up to 90 days for that doctor to appear on CMS’s verification list.  With the upsurge of enrollment applications CMS is likely to receive in the near future, it may take even longer for doctors not currently enrolled to become verifiable on the list.
This article details several stepsthat home health agencies should implement to protect themselves and their patients.  These steps will be labor intensive.  Before reviewing these steps, please take a moment to notify your federal legislator about this problem.  Even if you are not a provider directly affected by the PECOS enrollment rules, please contact your congress people to urge better protection for your community’selderly.  Forward the email you received or a link to this article to all your employees and patient/families who might help bring this impending crisis to the attention of your legislators.
1. Go to www.VoteSmart.ORG.
2. Enter your zip code at the top left of the page.
3. Find a list of your congressional representatives.
4. Click each representative.
5. Their contact information willappear at the bottom right.
6. Call each office or click through to each congress person’s website.
7. Advise your policy makers that a new deadline regarding CMS PECOS enrollment threatens to cut short the home health episodes of 40% of patients who need home health.  Most of these patients are not only elderly, but they are also ill or injured.  They are among the most vulnerable in oursociety.  We must give doctors more time to enroll in PECOS before throwing their patients into nursing homes.  We must enact the PECOS deadline in a way that does not retroactively penalize home health agencies for bills that were correct at the time of submission.
This PDF shows relevant passages of the Federal Register.  The first page gives additional means for commenting on this rule.http://edocket.access.gpo.gov/2010/pdf/2010-10505.pdf
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Action Steps for Home Health Agencies and DME Providers:
See if your referral sources are PECOS enrolled
* Go to this page on the CMS website: http://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp
* Download the list of PECOS enrolled doctors.  This list is a 13,000 page PDF document or a CSV with 72,000...