November 5, 2012:
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 are eligible to 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.
UPDATE:
Jurisdiction 11 Home Health and Hospice
Ordering and Referring Denial Edits Will Turn on May 1, 2013
Effective May 1, 2013, CMS will instruct contractors to turn on 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 claims including Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider
•Part A Home Health Agency (HHA) claims that require an attending physician provider
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Barnestorm Instructions:
1.Use Codes > Other Basic Codes > Doctors and click on the Update PECOS Y/N button in the middle of the screen.
2.You will see a progress bar as it walks through all the NPI numbers of all physicians who have had at least one verbal order or 485 in the past 400 days and determines their current PECOS status.
3.When the PECOS status check finishes, at the top of this screen, check the PECOS=N Only box and click the Print Codes button to get a list of the physicians who need your attention in regards to the CMS message above.