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CMS to implement ordering and referring denial edits beginning in January 2014



November 13, 2013
Area(s) of Interest: Payor Issues and Reimbursement Public Payors 

Physicians who refer or order services for Medicare beneficiaries must be enrolled with Medicare by January 6, 2014. Medicare contractors have been instructed to turn on ordering/referring physician edits on that date, and claims submitted on or after January 6 will be denied if the ordering/referring physician does not have an enrollment record.

The Centers for Medicare and Medicaid Services (CMS) began notifying ordering/referring physicians of the need to enroll in Medicare in October 2009. Enrollments can be completed via the online Provider Enrollment, Chain, and Ownership System (PECOS) or by completing a paper enrollment application (applicable CMS-855).

CMS had originally intended to turn on the edits last May, but the agency delayed implementation because of technical issues.

Physicians can confirm whether a referring or ordering physician is enrolled by downloading a report of all the eligible physicians and nonphysician practitioners who have current enrollment records from the CMS website. The report is updated weekly.

Click here for more information.

Contact: Michele Kelly, (213) 226-0338 or mkelly@cmadocs.org.

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