ADA calls new Medicare requirement 'burdensome'

The ADA is questioning a proposed federal rule that would require referring dentists to either enroll in Medicare's Provider Enrollment Chain and Ownership System (PECOS) or opt out.

After the ADA voiced concerns about "unintended consequences" of the interim final rule, the U.S. Department of Health and Human Services told ADA representatives at a July 1 meeting that a simplified process is possible, according to an ADA News story.

Officials with the Centers for Medicare and Medicaid Services said they were working on a simplified process, which could delay enforcement of the new PECOS enrollment requirements to 2012, the ADA News reported.

PECOS is designed to detect and fight Medicare fraud and abuse by improving the accuracy of enrollment data and help ensure that only qualified individuals and entities are enrolled with Medicare. One of the systems aims is to verify that referring and ordering providers are actually entitled by their education and licensure to perform the referrals.

The interim final rule would apply to dentists who order or refer items or services for Medicare beneficiaries, even if they do not bill Medicare or provide or supply Medicare-covered items or services. Such ordering or referring dentists will be required to either enroll in PECOS or opt out by completing and submitting the necessary forms.

The ADA believes as many as 180,000 dentists may be affected by the requirement to enroll or opt out and estimates that 3% to 4% of practicing dentists are enrolled in PECOS or have opted out.

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