Physicians who have not enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) or opted out of Medicare will not be able to order or refer Medicare patients for home health services. PECOS is the electronic enrollment database of Medicare providers and suppliers that has come under fire for being difficult to use, filled with outdated questions and riddled with erroneous data. Originally, the deadline to enroll was Dec. 31, 2009. It was delayed to April 5, 2010, and then to Jan. 3, 2011. In June, CMS attempted to move it again, to July 6, 2010, contrary to the intent of Congress, but relented following an outcry from the AMA.
Home care software developer HealthWyse is providing software and services for its clients to make it easier to comply with the new PECOS regulation. HealthWyse will offer a service that will automatically update the client’s physician database with the latest PECOS file from CMS. During the patient intake process, the software will indicate whether the referring physician is enrolled in PECOS. There will also be a Management List that will flag those physicians with active patients who are not yet enrolled.
HealthWyse spokesperson Steven Booth said the vendor’s objective is to help clients automate these administrative processes so that they can focus on providing patient care. “This is an example of the advantages of deploying a hosted architecture,” Booth said. “Because we host the master copy of our client’s database, this is a relatively easy solution for us to put into place.”
HealthWyse customers also routinely replicate their data locally in order to maintain their own mirrored-copy. Some use a web-browser to access their data directly from the HealthWyse data center. “In either case,” Booth added, “HealthWyse automates updating PECOS data.”
Since October, 2009 Medicare EOB’s have included warnings about non-compliant physicians. Eventually, home care intake personnel will find themselves in the awkward position of having to refuse a patient and inform the referring physician the refusal is due to his or her failure to register in the PECOS database, preventing the home care agency from being paid if they were to provide services.
What is not clear yet is whether Medicare contractors will attempt to recoup monies paid during the warning period in a future audit. Since a payment denial reason such as this one is easily detected through automated computer audits, there is reason to believe it will attract the attention of Recovery Audit Contractors (RAC) if they ever turn their attention to home care.
Home infusion providers have an option if their software vendor does not offer a PECOS search function such as the one HealthWyse has announced. Rock-Pond Solutions, of Conway, Arkansas, released a PECOS Database Audit tool that will extract physician lists from CPR+, HomecareNet, Ascend-HI and Ascend or receive an Excel file from any system and audit it against the CMS PECOS database.
Rock-Pond CEO Pete Tanguay explained that his $600 service will provide audit results within 24 hours, notify the user when CMS updates its published data file, accept user physician files for PECOS audit an unlimited number of times for a year. Rock-Pond will accept physician files and process them at no charge through the end of July.
