The National Association for Home Care and Hospice released the following information today (July 2, 2010):
"Many of you have expressed concern about the language in the PECOS Press Release issued by CMS on June 30th and asked for an interpretation. NAHC requested clarification from CMS, and received the following response from the CMS Acting Administrator:
'What we said yesterday is that we will not look to the PECOS system as our only tool for determining if physicians are participating in the program. We have system capacity issues in PECOS that we are working to resolve --so we will work with everyone to assist in their enrollment (sic) and use all available sources (such as other files and manual submissions) to verify physician status. Folks are still required to submit their information per statutory deadlines and we will continue to monitor appropriate use. Until we work out the issues with PECOS, we will continue to pay claims as we do today, i.e., will not automatically reject claims that do not include a PECOS enrollment number.'
This message clearly identifies CMS intention to require that physicians ordering home health services be enrolled in Medicare in accord with ยง6405 of the Affordable Care Act, but that enrollment in PECOS will not be required at this time because of the 'system capacity issues in PECOS.' Therefore NAHC is recommending that, in the event the physician is not in PECOS, HHAs should:
- Ask the physician whether he/she is enrolled as a participating or non-participating physician, or has attempted to enroll, or is in the process of attempting to enroll in Medicare, or has filed an affidavit to officially opt-out of Medicare
- If the physician responds in the affirmative, the HHA may initiate and/or continue care
- Document the physicians response in the patients' records
- If the physician does not respond affirmatively to these questions, assist the physician in enrolling prior to accepting the patient into care and document the initiation of the enrollment effort
NAHC has also asked CMS to take the position that any HHA that submits a claim in good faith, believing the doctor is enrolled or has attempted to enroll, will not face a retroactive recovery. This is based on the Medicare provision that protects providers from recovery of any overpayment if they are "without fault." We are awaiting a response from CMS on application of the "without fault" provision.
NAHC has evaluated the possibility of filing a lawsuit, asking for an injunction against CMS. However, based on the language in the CMS Press Release, we believe that the court would not agree that there would be irreparable harm to Medicare beneficiaries and home health agencies. Specifically because, CMS wrote "until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid.
We urge home health agencies to submit their comments to the Federal Register Notice of the Interim Final Rule according to instructions found on p. 24437 at this link. before 5PM on July 6th."
TAHC&H Action Taken:
TAHC&H would like to thank agencies for their advocacy in this area. Your letters and action have highlighted the importance of our services to Medicare beneficiaries to CMS and our elected officials.
On Monday, June 28th TAHC&H received a call from WOAI channel 4 in San Antonio asking for information on the rules related to PECOS and the effects it was having on Medicare patients and the industry. TAHC&H shared information about the rules and member agency Patience Home Health and one of their patients was interviewed for the story. We were told after the story broke that CMS released their Wednesday June 30th press release in response to WOAI's inquiries as they were the only news organization to have contacted the CMS press office. Click here to view the story.
TAHC&H set up laptops at the Administrator Conference earlier this week so that attendees could send an e-mail message to the Texas U.S. Senators and their Congressperson. We have also had our lobby team in Washington, D.C. as "feet on the ground" advocates to explain the issue created by the provisions in the law setting the July 1, 2010 deadline effecting home health and DME. U. S. Representatives Charlie Gonzalez and Eddie Bernice Johnson have been particularly engaged in the matter for TAHC&H. Rep. Johnson has started a "Dear Colleague letter" for them to sign on to a letter to CMS asking them to move the start date to January 3, 2011.
Resources available:
TAHC&H has posted resources on its home page (www.tahch.org) ALERT for agencies to use to assist in determining if a physician is enrolled in Medicare and/or in PECOS. Click here to view a free searchable database that will sort your physician inquiry by NPI and will let you know BOTH their Medicare enrollment status and their PECOS enrollment status.
The AMA has also made available resources for physicians to help them navigate the enrollment process. TAHC&H has also made this link available from our home page so that you can assist your physicians with becoming enrolled. Click here.
