Following its debut last October, ContinuLink has made headlines more than once. Most recently, the company seems to have beaten its more seasoned colleagues to the punch by offering its 30-plus customers what may have been the first PECOS integration tool for check a physician’s eligibility to make home care referrals under new CMS rules.
Having 30-plus customers online before its first anniversary celebration is a headline in itself. Vice president of sales and marketing Brad Caldwell attributes the Atlanta-based company’s early success to a unique pricing model, based on a percentage of revenue rather than per-seat licensing.
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PECOS History: Constant As A Raging River November 2003: CMS debuts PECOS as a manual signup system. December 2008: CMS introduces Internet PECOS; physicians must apply online, including re-enrollment by all physicians already in Medicare prior to November, 2003.
October 2009: Fiscal intermediaries begin Phase One, claims rejection warnings to non-enrolled physicians. Phase Two was to have been actual payment denials. Physicians report the warnings are confusing.
December 2009: CMS delays claims rejection deadline from 12/31/09 to 4/5/10.
February 2010: AMA lobbies for more time; CMS moves deadline to 1/3/11.
May 2010: CMS issues interim final rule, suddenly accelerating the deadline six months to 7/6/10 but only for physician referrals to other providers, citing the newly enacted health reform law as the reason. However, it extends claims denials to include not only home medical equipment and home health services but also specialist, laboratory and imaging services, arbitrarily going beyond the law’s language and intent. The AMA and other physician organizations mount a massive lobbying attack, citing numerous instances of PECOS system glitches delaying attempted enrollments for months and occasionally accidentally issuing some physicians new NPI numbers, cutting off all payments. They push for reinstatement of the 1/3/11 deadline.
June 30, 2010: CMS acknowledges PECOS system weaknesses; announces it will not begin to reject claims on July 6 but does not indicate when it will begin to do so. It also announces a contingency plan to ensure only eligible physicians issue referrals but does not describe the plan. |
A company news release indicates that ContinuLink rolled out a real-time PECOS support tool, offering cross-verification of provider names, on June 28, four days after CMS released its new PECOS regulation. Without leaving the ContinuLink application, customers are now able to see whether their referring physicians have registered with the PECOS database.
“ContinuLink believes we were the first system in the country to have integrated real-time PECOS support with cross verification of provider name with NPI and PECOS files to assure claims are not rejected incorrectly,” Caldwell said.
ContinuLink CEO Satish Movva added, “This highlights the strength of using a centrally hosted, web-based system, where updates and system enhancements can be rapidly and seamlessly rolled out without user intervention and without service interruption.”
We spoke with Terri Santangelo, RN, BSN, VP of Clinical Operations with ContinuLink’s newest client, FirstLantic Healthcare, Inc. in Delray Beach, Florida. Ask if her agency was struggling with PECOS, Santangelo could only manage a restrained “Ugh!” but said she is looking forward to getting through training and going live on October 1 and beginning to use the new vendor’s PECOS lookup feature.
In addition to the PECOS enrollment and physician name cross verification, ContinuLink also enhanced the system to automatically take pending enrollments into account. On June 30, additional functionality was added to give real time verification of new physicians as new referrals or physicians were entered into the system.
The machine readable file for this initiative became available to software developers June 24. Following complaints from the AMA, the PECOS deadline and scope of claims marked for payment denial has changed numerous times since December, 2008. (see Sidebar: “PECOS History”)
One ContinuLink customer, Sarah Ahmed of Fresno, California, noted her vendor’s foresight, stating, “We came in on Monday morning thinking, as most home care providers did, that we would have to start manually checking each referring physician by hand but we found that all of our physicians were already checked for PECOS eligibility by name and NPI.”
About Continulink
ContinuLink provides a hosted, “Software as a Service” (SaaS) application for home health care, hospice, private duty and supplemental medical staffing businesses. The company was incorporated in Delaware on July 20, 2009 and is owned by Sentinel Capital Partners of NYC. Interim Healthcare remains its largest customer.
