CMS has just announced that the deadline for Medicare ordering/referring doctors to be in the Provider Enrollment, Chain and Ownership System (PECOS) enrollment database has now been delayed (from April 5 2010) until January 3, 2011. 

The PECOS database began in 2003, so thousands of ODs who enrolled in Medicare prior to 2003 will need to re-enroll -- on paper or online -- in Medicare as if they are enrolling for the first time. CMS plans to send a letter to all physicians who last enrolled more than 6 years ago to remind them to re-enroll.

According to the AOA, members should not necessarily rely on a letter or future notification from CMS.  Instead, doctors should strongly consider re-enrolling in Medicare this year if they receive such a letter or if they find themselves absent from the Medicare list of “eligible” professionals for ordering/referring.  A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and also contains the physician/non-physician practitioner’s National Provider Identifier (NPI)

Further, according to CMS, providers who order or refer may want to verify their enrollment in PECOS. They may do so by accessing Internet-based PECOS at https://pecos.cms.hhs.gov/pecos/login.do on the CMS website. Before using Internet-based PECOS, providers should read the educational material about Internet-based PECOS that is available at http://www.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp 

Please note that due to scheduled maintenance, PECOS will be unavailable from Monday, March 29, 2010 through Monday, April 5, 2010.

Keep in mind that as of January 3, 2011, if the ordering/referring provider is not in PECOS, the carrier or Part B MAC will search its claims system for the ordering/referring provider. If the ordering/referring provider is not in PECOS and is not in the claims system, the claim will not be paid. It will be rejected. If the ordering/referring provider is in PECOS or the claims system but is not of the specialty to order or refer, the claim will not be paid. It will be rejected.

More information will be provided as it becomes available.