Endocrine Insider
December 10, 2009

(See Full Issue)

Combined efforts by The Endocrine Society, American Medical Association, and other specialty societies have resulted in the postponement of a new policy scheduled to go into effect January 1, 2010, which likely would have resulted in physician nonpayment for legitimate claims. On October 5, 2009 the Centers for Medicare and Medicaid Services (CMS) began marking for nonpayment legitimate and accurately filed claims because physicians and other health care providers were not appropriately enrolled in the Provider Enrollment, Chain, and Ownership System (PECOS) database. Developed in 2003, PECOS did not automatically include physicians who were enrolled in the Medicare program in prior years; those physicians must actively enroll in PECOS. CMS determined that any physicians not enrolled in the PECOS database by January, 2010, as well as the physicians and other health care practitioners to whom the non-enrolled physicians refer patients, will not be paid for their services. As a result of the Society’s successful advocacy efforts, the implementation date for this policy has been pushed back to April 5, 2010.

There are many concerning issues with this policy, including the fact that most physicians and other providers have only just begun to learn of its existence. Additionally, physicians have no practical or convenient way to determine whether the physicians or health care providers who refer patients to them are in the PECOS database, thereby risking non-payment for services if the referring physicians are not enrolled. Medicare has created additional information on the PECOS database, including instructions on how to enroll and what to expect as the implementation date nears. This information can be found at https://pecos.cms.hhs.gov/pecos/login.do.