Latest CMS Updates from Home Care Software

Major Improvements to the Internet-based PECOS System

Over the last year, we have listened to your feedback about Internet-based PECOS. We have made improvements to increase access to more information. PECOS is easier to use than ever with the following upgrades that are now available:

• The electronic signature emails to the Authorized Officials have been updated. The new emails will include the Provider/Supplier’s name as well as “1 of 2 emails” or “2 of 2 emails” in the subject line. Email 1 of 2 will contain the Web Tracking ID to be entered on the PECOS E-Signature page and email 2 of 2 will contain the PIN for the PECOS E-Signature page. The body of the email also contains additional information about the application, including:
• LBN or First Name/Last Name
• Provider/Supplier Specialty
• State
• Form Type
• Practice Location
• NPI
• SSN/EIN (Last 4 Digits Unmasked)

• Providers/Suppliers are now able to see all of their Medicare IDs in Internet-based PECOS, including Medicare IDs (Provider Transaction Access Numbers (PTANs)) associated with reassignment of benefits, practice locations, and Other Medicare IDs. Other Medicare IDs are Medicare ID(s) that are associated with the specific enrollment record for claims payment purposes, but are not yet directly linked to a Practice Location or a Reassignment of Benefits within PECOS.

When there are Medicare IDs listed in the enrollment, PECOS will display the “View Medicare ID Report” hyperlink on the “My Enrollments” page.  The “View Medicare ID Report” is also available in the Topic View tab within a specific enrollment record.

• Providers will now have access to an Advance Diagnostic Imaging (ADI) Accreditation Report. This report is accessible from the “My Enrollments” page by selecting the “View” button for a specific enrollment. This report will display the modalities that the provider is accredited for, the effective and end dates and the Accrediting Organization. This report is also available if performing a Change of Information (COI) under the Physical Location and Special Payments section.

The ADI Accreditation Report displays up to 50 records on the screen. If more than 50 records exist, the provider will be prompted to download the report into an Excel spreadsheet by clicking the “Generate Report” button at the bottom of the screen.  

• Individual providers that are currently enrolled in Medicare solely to order, but wish to enroll to be reimbursed by Medicare for services furnished can convert their existing CMS 855O enrollment application into a CMS 855I enrollment application. Please refer to the “Converting Existing CMS 855O enrollment to CMS 855I” on the CMS website.
• Providers and Suppliers completing a CMS 855B enrollment will now be able to designate their practice location type as a Critical Access Hospital (CAH) or a Skilled Nursing Facility (SNF).
• Federally Qualified Health Center (FQHC) applications will now be routed to the correct Medicare Administrative Contractor (MAC). A new question has been added asking if the provider is a Tribal Owned FQHC. Based on the provider’s selection the Internet-based PECOS application will be routed to the correct MAC. 

 

To access internet-based PECOS, go to the PECOS website.

 

 

Home Care Software Solutions, Inc.  provides integrated home health software solutions with CareSmart AMS software.

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Copyright © 2011 Home Care Software Solutions.  All rights reserved.

CMS Final Rule: Physician Enrollment before Ordering Home Health

Final Rule Released: Physician Enrollment and More

In May 2010, the Centers for Medicare and Medicaid Services (CMS) published an interim rule, with comment period, which required physician enrollment in Provider Enrollment, Chain, and Ownership System(PECOS) before referring and ordering home health and other services. This rule, although effective July 1, 2010, was not enforced because CMS had to solve issues with things, including the PECOS systems.

On April 24^th, CMS published the final rule, Medicare and Medicaid Programs: Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements, which appeared in the Federal Register on April 27^th.

The final rule differs from the interim rule. First of all, language was amended to clarify the enrollment requirement to say enrollment in “Medicare-including PECOS or other Medicare enrollment systems.”  According to CMS, work is underway to transition all physician enrollments to PECOS from other systems.

Some additional highlights of the final rule include:

• Requires that all providers of medical and other items/services who qualify for a National Provider Identifier (NPI) must include the NPI on all Medicare and Medicaid enrollment applications and claims submitted.
• Plans to activate edits for Medicare and Medicaid home health claims for physician’s legal names and NPI numbers.
• Residents who are state-licensed and enrolled in Medicare may order and certify homecare services.
• Physicians who comply with the official “opt out” requirements will be entered in PECOS
• Requires all physicians and other professionals who order and certify homecare be enrolled in Medicare.
• Enrollment in Medicare would be based on the date services begin and apply to both the RAP and claim. That said, Medicare won’t deny payment for any portion of the episode if the physician terminates enrollment.
• Providers cannot use HHABNs to notify patients when the reason for non-payment is failure of the physician to be enrolled in Medicare.
• Mandates document retention and provision requirements on providers/suppliers who order and certify items/services for Medicare beneficiaries.
• Clarifies that in-hospital services that are covered under the inpatient PPS will not be subject to this requirement; however, in-hospital diagnostic testing not paid under the PPS will be.
• CMS will provide notice to providers when the enrollment edits are activated.

Access the final rule here.

Copyright © 2011 Home Care Software Solutions.  All rights reserved.