Hospice providers must now adjust their operations slightly to accommodate another change from the Centers for Medicare and Medicaid Services (CMS). Effective June 3, 2024, CMS requires physicians certifying Medicare beneficiaries for hospice services to be enrolled in or validly opted out of PECOS (Provider Enrollment, Chain, and Ownership System) as a condition of payment. This comes ahead of proposed updates from CMS that could see pay rates rise, a new assessment tool and changes to patient surveys.
To understand the changes and how they will affect Axxess users, Senior Implementation Consultant Rosena Clarke-Turner RN, MSSW and Product Support Manager Karen Chamberlain RN hosted a webinar to talk through this update and share insight into how hospices can easily incorporate this new step into their workflow.
PECOS Enrollment Requirements
The changes are part of the Affordable Care Act and shouldn’t cause major disruption for physicians or hospices. In a set of frequently asked questions provided by CMS, the agency notes that those who can certify a patient for hospice will remain the same:
- Hospice medical director or the physician member of the hospice interdisciplinary group who certifies the patient’s terminal condition
- Patient-designated attending physician (if they have one) who certifies their terminal condition
Physician enrollment or opt-out is captured using Medicare’s PECOS or Provider Enrollment, Chain, and Ownership System. Currently enrolled or opted-out physicians don’t need to take any action.
“The basic concept is that except for the new enrollment or opting out, nothing else changes regarding who may certify for terminal illness,” said Clarke-Turner.
Streamlined Support in Axxess Hospice
Axxess took proactive steps to support clients ahead of the new PECOS documentation requirement with the release of enhanced functionality in Axxess Hospice.
During the webinar, Chamberlain outlined several of these enhancements including:
- Updates to the PECOS enrollment functionality
- Notifications for certification documents
- Reports for tracking PECOS eligibility and claim holds
“You want to make sure that you are reviewing your claim holds … and that you are doing your due diligence to make sure that you get your full revenue,” said Chamberlain. She emphasized that the solution updates are designed to provide hospices with the tools necessary to ensure compliance with these new regulations.
Be Proactive
Taking the initiative was a theme for the webinar as Clarke-Turner noted several resources to help hospices adjust to this change and other changes coming soon from CMS.
“It’s extremely important that you make yourself aware of what is coming down the pipe so that you can make the necessary adjustments,” said Clarke-Turner.
She shared additional resources including links to the Ordering and Referring Data File, FY 2025 Hospice Proposed Rule, and National Plan and Provider Enumeration System (NPPES).
To watch the full webinar on the new hospice PECOS requirements, click here.
Axxess Hospice, a cloud-based hospice software, includes simple tools such as intuitive medication management and real-time plan of care updates to help keep organizations compliant.
