As a follow-up to our ordering and referring providers in PECOS story this week, here's a Feb. 19 statement from CMS on this issue:

CMS will delay until Jan. 3, 2011, the implementation of Phase 2 of Change Request (CR) 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)) and CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)). 

The uncertain future of Medicare payment rates might be playing a role in physician participation with the Medicare program.

I spoke with American Academy of Family Physicians (AAFP) President Lori Heim, MD, today and she mentioned 87% of AAFP members were Medicare participating providers in 2009. That's down five percentage points from 92% of its members with par-status in 2008. She added she's hearing more and more physicians are making the tough decision to not take on new Medicare patients, too.

CMS announced today the agency will delay the new ordering and referring PECOS rule until Jan. 3, 2011.  

Under the rule, Medicare providers will receive denials for services (such as a lab test or office visit) that stem from referrals or orders from providers not in CMS's Provider Enrollment Chain and Ownership System (PECOS) - even when the billing provider's enrollment information is in PECOS. The rule was to take effect April 5.

The 7-month, Medicare pay-fix section in the Senate jobs bill has been carved out -- leaving no clear path to removing the 21% payment cut set for March 1.

Senate Majority Leader Harry Reid (D-Nev.) cited concerns about the overall size of the bill for removing several provisions, including the pay-fix language, that amounted to $70 billion. So, it's looking more and more likely that the 21% cut will go through without further delay.

Senate Democrats are moving to create a seven-month, pay-fix patch that moves the 21% cut to Medicare reimbursements from March 1 to October 1, 2010. A draft version of the Senate's jobs bill obtained by Part B News contains the temporary "doc fix" and several other Medicare provisions, such as an extension of the Geographic Practice Cost Indices (GPCIs) work floor and therapy caps exception.