A new PECOS list posted by CMS eliminates almost all of the guesswork when it comes to checking on the status of enrolling physicians. As of July 12, 2010, suppliers can now check to see whether their physicians’ applications are pending contractor review.

CMS has posted two new lists to the Medicare Provider and Supplier Enrollment section of their website: 

• Initial Physician Applications Pending Contractor Review [ZIP, 719KB]
• Initial Non Physician Applications Pending Contractor Review [ZIP, 91KB] 

ClaraVista’s Maureen Bacon was able to confirm with CMS that the lists are exactly as the titles imply; they include the names and NPIs of those physicians and non-physician practitioners whose PECOS applications have been submitted for review.

The publication of these lists follows a recent series of positive breaks for DME suppliers, who are now able to easily identify PECOS enrolled physicians via a frequently updated .csv data file (for more information see CMS Updates CSV PECOS List More Frequently; Twice per Week). Rather than calling a physician’s office directly, suppliers now have an alternate resource to confirm whether a physician has at least submitted their PECOS or CMS-855 enrollment application.

As applications are processed, physicians will be removed from the pending review list and added to the Medicare Ordering and Referring File, which was also updated on July 12, 2010. We expect the two review lists will be updated with the enrollment file simultaneously. As of late, the .csv file is being updated twice per week. You may download the latest version of all three lists by visiting:

http://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp.

We recommend suppliers note the date a physician first appears on the pending review list. If a particular physician’s name remains on the list for an extended period of time, it may be a sign that their Certification Statement has not yet been submitted. At the end of the online enrollment process, physicians are required to print, sign and mail in a paper Certification Statement, and contractors will not process a PECOS application until that statement is received. For physicians whose applications linger on as pending, a phone call may be warranted to confirm whether their Certification Statement was mailed in.

With the establishment of the July 6^th physician enrollment deadline, a recent surge in applications may have contributed to processing back-logs for some contractors.

Suppliers and physicians who owe back-taxes to the IRS may want to get their accounts squared away as soon as possible. According to a recent piece of legislation passed by the Senate, suppliers who owe on their taxes are seen as more likely to commit Medicare fraud and abuse than those who don’t and could become subject to additional scrutiny during enrollment.

The legislation, entitled the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962), would require the IRS to inform the Department of Health and Human Services (HHS) about “delinquent tax debts” held by physicians and suppliers who apply to enroll or reenroll in the Medicare program. Upon request, the IRS must confirm the identity of the party in question and provide HHS with information on the amount of tax owed by the individual, along with the year to which the debt applies.

The bill would grant the Secretary the authority to use this tax information when determining whether a physician or supplier is eligible to enroll or reenroll in the Medicare program. Suppliers and physicians with delinquent tax debts – defined as debt for which a lien has been issued, or a collection hearing is in process, and no payment arrangements have been made - may be subjected to periods of enhanced oversight or denied enrollment entirely. The Secretary is also granted the authority to adjust Medicare payments to suppliers and physicians based on the amount of delinquent tax owed.

As you may recall, H.R. 3962 was once known as the Affordable Health Care for America Act and was originally passed in the House as their version of healthcare reform. Because the U.S. Constitution requires all revenue-generating bills to originate in the House, the Senate took H.R. 3962 (a House originated bill), completely stripped it of all original content, renamed it, and is now using it as a medium for the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.

Before this bill may become law, the House and Senate must marry their two versions of the bill together and reconcile their differences. Since this bill is completely unrelated to the original version, members of the House will likely vote to reject the bill entirely or accept it only on the condition that certain amendments are included. If amendments are made to the bill, it will once again go back to the Senate for approval.

It’s possible that Congressmen whose healthcare reform ideas were not included in the signed Patient Protection and Affordable Care Act (PPACA or H.R. 3590) may continue to fight for their inclusion in this bill, and we may see several unrelated amendments added to the bill in order to secure votes.

We will keep you apprised of any updates or changes to the bill’s status in our August issue of Vista Notes. You may also read the full text of the bill here:  http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3962.

When given the opporunity, we like to tinker with new ideas and get our creative juices flowing. Recently, our marketing department started to experiment with creating short clips to help advertise what we do. We thought these turned out pretty neat and wanted to share them with you. Enjoy!

Can’t see this clip? Visit: http://www.youtube.com/user/MiraVistaLLC#p/a/u/1/lVpDOrNee6M.

Can’t see this clip? Visit: http://www.youtube.com/user/MiraVistaLLC#p/a/u/0/9DMnDMejapI.