Durable Medical Equipment (Orthotics/Splints)
CMS has established the online Provider Enrollment, Chain and Ownership System (PECOS) as an alternative to the paper (CMS-855) enrollment process. PECOS will allow physicians, non-physician practitioners and provider and supplier organizations to enroll, make a change in their Medicare enrollment, view their Medicare enrollment information on file with Medicare, or check on the status of a Medicare enrollment application via the Internet.
Durable medical equipment, prosthetics, orthotics, and supplies. Sometimes, durable medical equipment is referred to as DMEPOS because Medicare also covers prosthetics, orthotics and certain supplies (POS).
- Effective July 6, 2010, CMS has published an interim final regulation that requires DMEPOS suppliers (you) to include on claims the legal name and National Provider Identifier (NPI) of the referral source (physician or eligible professional).
- Effective January 3, 2011, anyone wishing to become a Medicare provider must apply through PECOS.
- Effective January 3, 2011, anyone registered as a Medicare provider will have to use PECOS to update their information.
- Effective January 3, 2011, as the supplier of the DMEPOS, you will be denied payment if your referral source is not enrolled in PECOS.
- In most cases, your referral source must be enrolled in PECOS not you as the supplier of the DMEPOS.
- Some therapists are receiving letters from CMS stating they must register with PECOS. If you are a DMEPOS supplier and you have not updated your Medicare enrollment information since 2003, it is recommended you register with PECOS.
CMS website: www.cms.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp
AOTA website: www.AOTA.org (enter PECOS in the site search engine – there are several articles)
APTA website: www.APTA.org (enter PECOS in the site search engine – there are several articles)
Reimbursement Changes – Your Attention Required!
On June 25, 2010 the Centers for Medicare and Medicaid Services (CMS) released the proposed 2011 Medicare fee schedule and revised payment policies.
- 41% reduction in reimbursement
-23.5% reduction to update sustainable growth
-12% reduction by combining OT, PT, SLP and paying 100% of the most expensive code on that day and 50% on all subsequent codes
-6.1% fee schedule reduction at the beginning of the year
- Change in the way you do business?
- Discontinue treating patients with Medicare?
- Take a personal pay cut to stay in business?
- Never allow OT, PT, SLP to see patients on the same day?
- Click here to see full positions from ASHT, AOTA, APTA
The practice management and reimbursement division of ASHT urges you to complete and send the sample letter to Donald Berwick, M.D. Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services.
