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Date
2013-03-20
Event
Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DMEPOS, and Part A Home Health Agency (HHA) Claims
Topic
Provider/Supplier Enrollment

 

UPDATE: Temporary Delay in Implementing Ordering and Referring Denial Edits 

Due to technical issues, CMS announced on April 25 that  implementation of the Phase 2 ordering and referring denial edits is being delayed. These edits would have checked the following claims for an approved or validly opted-out physician or non-physician who is an eligible specialty type with a valid individual National Provider Identifier (NPI). If either of these were missing or incorrect, claims would deny.  

  • Medicare Part B claims from laboratories, imaging centers and Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider; and  
  • Part A Home Health Agency (HHA) claims that require an attending physician provider. 

CMS will advise providers of the new implementation date in the near future. In the interim, informational messages will continue to be sent for those claims that would have been denied had the edits been in place.  For more information, see the revised article  SE1305 – Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims.

 

Description:
CMS subject matter experts provide an overview of the Phase 2 denial edits on the following claims to check for a valid individual National Provider Identifier (NPI) and to deny the claim when this information is missing:

  • Medicare Part B laboratory and imaging claims and Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) claims that require an ordering or referring physician/non-physician provider; and
  • Part A Home Health Agency (HHA) claims that require an attending physician provider.

When: Wednesday, March 20, 2013

Time: 3:00 PM - 4:00 PM Eastern Time

Target Audience:
Part B providers which order, refer and/or bill for these services
Home Health Agencies

Agenda:
Provider Types Eligible to Order/Refer
Action Steps for Billing Providers
Action Steps for Providers Who Order/Refer
Resources

Call Materials:
Presentation

Registration:
To register for a National Provider Call, please visit the CMS Upcoming National Provider Calls webpage.

For More Information:
Visit the Medicare Provider-Supplier Enrollment Website.