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The Centers for Medicare & Medicaid Services (CMS) issued an interim final regulation on May 5, 2010 implementing provisions of the Affordable Care Act that permit only a Medicare-enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and certain items and services under Medicare Part B. The new law applies to orders, referrals and certifications made on or after July 1. However, according to a June 30, 2010 press release from CMS, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in the Provider Enrollment, Chain and Ownership System (PECOS).

PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program. CMS was to automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their PECOS applications approved by July 6, 2010. However, CMS did not implement these changes as some providers have encountered problems enrolling and having their applications approved in the PECOS system.

According to CMS, 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.

TRICARE Management Activity is aware of the situation and is currently working with the Services to ensure all military providers complete the PECOS enrollment process. In the meantime, please do not reject referrals from military providers that have not completed their PECOS enrollment. TriWest Healthcare Alliance will provide future updates on this topic as they are available.