CMS delays enrollment deadline for referring physicians until 2011

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The Centers for Medicare & Medicaid Services (CMS) has further delayed the enrollment requirement for referring or ordering physicians in Medicare's Provider Enrollment Chain and Ownership System (PECOS) until Jan. 3, 2011.

Initially, the requirement was to be met by Dec. 31, 2009. However, a Medicare-run test on how many claims would be denied if the policy were to go into full effect found that over one-third of all physicians who are supposed to be enrolled in PECOS had not done so. CMS then decided to delay the requirement until April 5 of this year, but last week CMS announced the requirement had again been delayed until the beginning of next year.

According to the American College of Radiology (ACR), the requirement was delayed because there is a concern that a large percentage of providers are still unaware of the requirement and have yet to comply.

The ACR released a statement last week expressing its "concern" about the impact this situation could have on its members. "The requirement by Medicare is for all physicians who are involved in the Medicare to be enrolled in the PECOS," said the ACR. "This means that if a radiologist or radiation oncologist bills Medicare for a service provided and the referring physician who ordered the service is not enrolled in PECOS, then the claim may be denied payment to the radiologist or radiation oncologist."

According to the ACR, the most recent delay allows for claims to continue to be monitored, processed and not to be rejected if the referring and ordering physicians on Medicare claims are not enrolled in the PECOS until Jan. 3, 2011. Claims coming from a radiologist where the referring or ordering physicians are not in the PECOS will be marked with an error message until the referring or ordering physician establishes or updates his or her enrollment record.

CMS has made the names and NPIs of the Medicare physicians and non-physician practitioners who are already enrolled in PECOS publicly available on the CMS Web site and the ACR is recommending that its members contact those referring physicians who are not on the list to remind them that they need to enroll in the PECOS by Jan. 3, 2011.