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CMS to implement Medicare ordering, referring edits May 1
e-Reports, April 15, 2013
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The Centers for Medicare & Medicaid Services (CMS) will implement ordering/referring provider edits May 1. The change will require physicians who refer or order services for Medicare patients to be enrolled in Medicare.

This edit applies to Part B providers who refer and/or bill for laboratory and imaging claims, durable medical equipment, orthotics and supplies, as well as Part A home health agencies that require an attending physician. These claims will be processed only if the physician ordering or referring has a current Medicare enrollment record, a valid National Provider Identifier (NPI) and if the physician is eligible to order or refer for Medicare patients.

If the ordering/referring physician does not pass the edits, the claim will be denied and the billing provider will not be paid. Physicians with a valid opt-out affidavit on file are not required to enroll in Medicare.

For more information, see this CMS article.

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