AMA Wire

Wednesday, May 2, 2012

This Week's News

Changes to Medicare enrollment rule reflect feedback from physicians

Changes to Medicare enrollment rule reflect feedback from physicians

Physicians enrolled in Medicare through its legacy system can continue to order and refer without immediately re-enrolling through the cumbersome Provider Enrollment, Chain and Ownership System (PECOS), according to a final rule issued by the Centers for Medicare & Medicaid Services (CMS).

The final rule, issued April 27, eliminates many of the challenges posed by the interim final rule. The AMA has been urging CMS to revise many of the proposed requirements, which would disrupt access to care for Medicare patients, interrupt legitimate payments and care coordination, and cause other administrative hassles.

While CMS has been working to update the PECOS database with complete enrollment information, the process has been cumbersome for physicians and other health care providers.

The final rule reflects a number of the comments submitted by the AMA and 42 medical specialty societies after the interim final rule was proposed, and CMS's ongoing efforts to streamline the enrollment process. The changes include the following:

  • Physicians will satisfy the enrollment requirement whether they have enrolled through PECOS or Medicare's legacy system.
  • Referrals to specialist physicians no longer require enrollment in PECOS.
  • Medical residents who are permitted by state law to order and certify services will be allowed to enroll in Medicare at the discretion of their institutions.
  • CMS will give a 60-day notice before denying claims to physicians who lack an enrollment record.

Physicians should take the following steps to meet the requirements of the final rule:

  • Enroll or verify enrollment in Medicare to avoid claim denials. Physicians who have opted out of Medicare are not required to enroll in PECOS.
  • Retain records of orders and certifications for seven years. Records may be paper or electronic.
  • Report their Type I individual National Provider Identifier (NPI) when ordering and certifying. This provision applies even if the physician is paid under a Type II NPI.

Visit the AMA's Medicare enrollment Web page for additional information.