| Update on Claims Processing for Ordering/Referring Providers |
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The Centers for Medicare & Medicaid Services (CMS) will delay until January 3, 2011, the implementation of Phase 2 of Change Request (CR) 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)) and CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)). This delay will give physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers sufficient time to enroll in Medicare or take the action necessary to establish a current enrollment record in Medicare prior to Phase 2 implementation. Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and contains the NPI. Under Phase 2 of the above referenced CRs, a physician or non-physician practitioner who orders or refers and who does not have a current enrollment record that contains the NPI will cause the claim submitted by the Part B provider/supplier who furnished the ordered or referred item or service to be rejected. CMS continues to urge physicians and non-physician practitioners who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003 to update their enrollment record now. If these physicians and non-physician practitioners have no changes to their enrollment data, they need to submit an initial enrollment application which will establish a current enrollment record in PECOS. ________________________________________________________________________________ _________ There's still time to get the seasonal flu shot! Although influenza activity has declined recently, it still may continue for several months.[1] The Centers for Disease Control continues to recommend that patients and health care providers and caregivers be vaccinated against seasonal influenza. CMS encourages health care providers to use each office visit as an opportunity to talk with Medicare your patients about the importance of getting a seasonal flu shot. And remember, it is also important to immunize yourself and your staff. Remember - Seasonal influenza vaccinations and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs. For information about Medicare's coverage of the seasonal influenza virus vaccine and its administration, as well as related educational resources for health care professionals and their staff, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website. You will find a variety of resources that explain Medicare coverage and claims submission policies related to the seasonal influenza vaccine. For information on Medicare policies related to H1N1 influenza, please go to http://www.cms.hhs.gov/H1N1 on the CMS website. [1] Seasonal Influenza (Flu). [online]. Atlanta, GA: The Centers for Disease Control and Prevention, January 19, 2010 [cited 21 January 2010]. Available from the World Wide Web: (http://www.cdc.gov/flu) -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- ------- Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser. If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/show_list_archives ) 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.hhs.gov/ContactCMS). Thank you. |