CMS will soon begin denying Part B, DME, and Part A HHA claims that fail the ordering/referring provider edits. These edits ensure that physicians and others who order and refer items or services have established their Medicare enrollment records and are of a specialty that is eligible to order and refer. CMS will provide 60-day advanced notice prior to turning on the Ordering/Referring edits. CMS does not have a date at this time.
If you order or refer items or services for Medicare beneficiaries, or bill for these services, please read these CMS resources to be sure you are following Medicare requirements. MLN Matters® Articles: § #SE1221 Phase 2 of Ordering and Referring Requirement<http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1221.pdf>, § #SE1011 Edits on the Ordering/Referring Providers in Medicare Part B, DME and Part A HHA Claims<http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1011.pdf> MLN Fact Sheets: § "Medicare Enrollment Guidelines for Ordering/Referring Providers"<http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MedEnroll_OrderReferProv_FactSheet_ICN906223.pdf> § "The Basics of Medicare Enrollment for Physicians Who Infrequently Receive Medicare Reimbursement"<http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MedEnroll_Phys_Infreq_Reimb_FactSheet_ICN006881.pdf> All providers may also confirm whether or not an eligible ordering or referring provider is enrolled in Medicare by reviewing the Ordering and Referring File<http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/MedicareOrderingandReferring.html> on the CMS website. ________________________________ If you know someone who would like to subscribe to a Medicare Fee-For-Service (FFS) provider listserv, go to http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads//MailingLists_FactSheet.pdf<http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MailingLists_FactSheet.pdf> and select the appropriate listserv to subscribe. If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/wa.exe?INDEX) to unsubscribe or to leave the appropriate listserv. Please DO NOT respond to this email. This email is a service of CMS and routed through an electronic mail server to communicate Medicare policy and operational changes and/or updates. Responses to this email are not routed to CMS personnel. Inquiries may be sent by going to (http://www.cms.gov/About-CMS/Agency-Information/ContactCMS/index.html). Thank you.
