Angela Hayden & Andrea Stark
Originally set to go into effect on May 1st, PECOS Phase 2 has been delayed…again. CMS issued word of the delay via their website citing technical issues with the claim processing side for correctly applying the PECOS edits that would have caused erroneous rejections. Specific information was not released regarding a timeframe for when the new deadline would be set. So for now, providers have an opportunity to complete their internal review process and avoid immediate claim denials.
Providers are familiar with the many delays that have affected the PECOS project. Due to repeated delays, Phase 1 has essentially been in effect for 3.5 years in one form or another; represented to providers via GEN response rejections (pre-5010) then as N544 remark codes on remittance advices (post-5010).
In March 2013, CMS announced that May 1st would be the Phase 2 implementation date. Yet five days prior to implementation, we have another delay. What does that mean to providers? At MiraVista we are advising providers “Don’t get too comfortable”. The delay is due to a technical issue and is not intended to offer providers a substantial break. We have no way to officially determine when a resolution will occur, but these types of minor issues can be fixed in as little as 30 days. As such, providers should continue to review their records and ensure accuracy to be prepared for implementation.
Another important announcement took place on April 24th, which was the introduction of HR 1717 by Congressman Tom Price of Georgia. Price kept to his word and introduced new legislation to repeal and replace the current Competitive Bidding Program with the Market Pricing Program (MPP). The bill text was released by Congressman Price’s office and proposes an end to Round 1 pricing effective December 31, 2013. The legislation also calls for an immediate cease to both Round 2 implementation and National Mail Order, suggesting the termination of any awarded contracts under these programs. These are hefty requests that are accompanied by a detailed plan of action for the transitional period between the termination of Competitive Bidding and the implementation of MPP. This transitional plan is an important part of the legislation in order to gain a budget neutral score by the Congressional Budget Office (CBO). We will keep you up-to-date as we continue to review the legislation and monitor its progress.
Providers are encouraged to reach out to their Representatives to gather support for the new legislation. AAHomecare has provided a template letter to assist in this process which can be accessed here: http://action.aahomecare.org/9244/stop-medicare-bidding-program-home-medical-equipment/. The bill was introduced with a total of 25 co-sponsors, so be sure to reach out and thank those congressional members who are in support of this pivotal piece of legislation. Providers can also show their support by joining AAHomecare on Capitol Hill for the Washington Legislative Conference on May 22-23rd to lobby on behalf of the DME industry (Register here: https://www.aahomecare.org/events/2013/5/washington-legislative-conference)