Delay in Medicare Ordering & Referring Denial Edits

    By: Melissa Zarzycki on Apr 30, 2013

    CMS has delayed implementation of the Phase 2 ordering and referring denial edits due to technical issues. The original implementation date was scheduled for May 1, 2013. CMS claims the delay is temporary, but has not announced the new date. We will post information, as it becomes available, in e-News and on the MSNJ website.  

    MSNJ worked with AMA to secure delays of the compliance date to allow a sufficient period of time for physician outreach and education. Billing physicians will not be paid for services if the ordering/referring physician is not enrolled or if ordering/referring information is complete. Physicians must list on a claim the name and NPI of the ordering/referring physician or provider. Paper filers are reminded that only the first and last name of the ordering/referring physician should be included on the claim; nicknames, middle initials, and/or credentials should not be included, as the claim will be denied.   

    Physicians who need to enroll are urged to do so now through Medicare's online PECOS website. The Texas Medical Association created a very helpful National PECOS Lookup Tool. Use this free tool to verify your Medicare ordering/referring enrollment status. Those who have opted out of Medicare do not need to enroll. View the MLN Matters article SE1305 and the AMA's FAQs on the Medicare Ordering/Referring Enrollment Policy. Read more about the delay.

    Released: April 30, 2013, 10:56 am
    Keywords: Announcements | NEWS

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