Medicare providers urged to enroll in online system to fight fraud

Medicare providers that have not updated their enrollment records in the past six years must re-enroll in the Centers for Medicare and Medicaid Services' online system because it cannot convert the old records, CMS officials said on Thursday.

During the past several months, CMS contractors have been mailing letters to providers participating in Medicare who are not listed in the upgraded system to ask them to register promptly.

In 2003, CMS launched the Provider Enrollment, Chain and Ownership System, a Web-based application that allows doctors and suppliers to manage their registration information such as credentials, specialties and phone numbers.

Agency officials said on Wednesday they are requiring providers to register in the system primarily to check the accuracy of payments. CMS had planned to start denying claims filed by providers who are not listed in PECOS beginning Jan. 3, 2011.

But after physicians voiced concerns that the deadline was unfeasible, the agency dropped the cutoff date. "No matter what happens, we will try to make sure that providers have at least 30 days notice before we automatically reject claims," CMS spokesman Peter Ashkenaz said on Thursday.

Medicare issued $47 billion in improper payments in 2009, which accounted for about 43 percent of the $110 billion the government wrongfully disbursed that year, Daniel Werfel, controller for the Office of Management and Budget, told a Senate panel on Tuesday. Complicating matters for CMS, the stimulus package calls for the agency to start cutting bonus checks up to $44,000 over five years to Medicare health care providers that install an electronic health records system. CMS said it will rely on PECOS to verify Medicare eligibility.

But some Medicare providers said they have had difficulty registering in the newer system, according to the American Medical Association. Last month, AMA President Cecil Wilson said his members "urge CMS to work collaboratively with us to address the systemic problems with enrollment, such as long processing backlogs and ill-equipped customer service lines, which prevent physicians from enrolling."

Changes to the Medicare program during the past decade have created enrollment backlogs and delayed the processing of physician applications, AMA officials contend. For example, the government required providers to switch from old billing codes to a standard unique identification number called the National Provider Identifier, they said.

CMS' computer systems are unable to transfer providers' old records to PECOS due to those modifications, agency officials said on Wednesday.

Ashkenaz said the agency has been working closely with AMA to resolve individual cases the association has brought to its attention. "We have made hardware and software changes to increase the capacity and stability of the PECOS system," he added. "We believe that these improvements address the issues that were raised in late June, early July with access to PECOS."

Some providers that have participated in Medicare for decades complain the re-enrollment process forces them to find codes long forgotten, and others are concerned they might not receive payments in a timely fashion.

CMS officials said providers and suppliers do not need a password if they mail a paper application to enroll in the system. In addition, a Medicare provider enrollment website contains instructions and other useful information about the enrollment process, they added.

CMS has established a workgroup dedicated to easing the process, Ashkenaz said. "We are continuing to update and streamline the provider enrollment process," he said. "We will continue to send informational notices to providers reminding them of the need to submit or update their provider enrollment records and we will work with the provider community to provide guidance on provider enrollment."