::Suffolk County Medical Society/Suffolk Academy of Medicine::

2010 Legislative Session – Summary to Date

Attached is a brief summary of the status of some of the more significant bills which MSSNY and New York physicians’ were/are following during this Session of the New York State Legislature. Since we have no final budget (the Senate failed to act on the “Revenue” bill) the members are not being paid. Clearly at some point the members will be called back to complete the business left unfinished. This report will be updated as events occur. Click Here for more information.

CMS FINALIZES REQUIREMENTS FOR THE MEDICARE ELECTRONIC

HEALTH RECORDS (EHR) INCENTIVE PROGRAM

CMS FINALIZES REQUIREMENTS FOR THE MEDICAID

ELECTRONIC HEALTH RECORDS (EHR) INCENTIVE PROGRAM

CMS FINALIZES DEFINITION OF MEANINGFUL USE OF CERTIFIED

ELECTRONIC HEALTH RECORDS (EHR) TECHNOLOGY

"Important Information from MSSNY"

IF YOU WANT TO CONTINUE TO BE PAID BY MEDICARE, BE AWARE OF PECOS

PECOS stands for Provider Enrollment Chain Ownership System. It is a provider enrollment system developed by the Centers for Medicare and Medicaid Services (CMS) in their attempts to eliminate fraud and abuse of the Medicare trust fund dollars. CMS wants active control over who is enrolled in the Medicare Program.

Historically, Medicare contractors like EBCBS, who operated Empire Medicare, had their own provider enrollment files/systems. Every Medicare contractor in the country had their own provider enrollment rules. CMS wanted to have greater control over who was being enrolled and how they were being enrolled so they developed the PECOS provider enrollment system.

When CMS developed their PECOS system, they did not ask any of their Medicare contractors for information or clarification of what the contractors’ databases contained. Therefore, the information that might currently exist in a Medicare contractor’s enrollment file may not comport with the data being asked for through the PECOS system. In addition, I don’t believe the existing enrollment systems of the Medicare contractors are compatible with the PECOS system. So it is not a process whereby the Medicare Contractor can copy the information contained in their existing files to CMS’ PECOS system. I believe that CMS, the government, also thinks that it can reduce the number of duplicative or erroneous provider numbers that might be on the contractors’ enrollment files nationwide.

The bottom line is in order to continue to be paid by Medicare for covered services; CMS is requiring/mandating enrollment in their PECOS system. This is especially true for practices that provide DME supplies and for practices that provide care on the basis of an order or referral from another physician. Ordered/referred care (i.e. DME, lab, and x-ray) must list the NPI of the ordering/referring physician on the claim submitted in order for their claim to be considered for Medicare payment. By January 3, 2011, if the NPI of the ordering or referring physician is not in the PECOS file, there is a large possibility that the claim for the ordered/referred service will be denied.

If a physician has not done anything to their Medicare enrollment since 2003 (i.e. changed a telephone number, moved the practice, changed the place where checks are sent, added or removed health care practitioners from the practice, etc.), then it is most probable that the physician/medical practice is not currently in the PECOS file. Please be sure to read the fourth paragraph of the attached item to discern whether or not the individual physician is listed in CMS’ PECOS System,

If you think you’re already in PECOS, verify your information by viewing the Ordering/Referring Report at the following website: www.cms.hhs.gov/MedicareProviderSupEnroll click on “Ordering/Referring File” on the left-hand side. Next, scroll down to the DOWNLOAD section and click on the report link. Note, the report is over 13 thousand pages long. So, it is NOT meant to be printed. If you find your name AND your NPI, you do not need to take further action. If not, you need to enroll in CMS’ PECOS File at https://pecos.cms.hhs.gov

If you have any additional questions, please let me know.

Regina McNally, VP

Division of Socio-Medical Economics

Medical Society of the State of New York

865 Merrick Avenue

P. O. Box 9007

Westbury, NY 11590

516-488-6100, ext. 332 OR Fax: 516-352-4093

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