CMS Tightens Rules for Physicians Who Order, Refer
Published: 2009-11-03 01:09:57
Author: AAFP | October 30, 2009
Effective Oct. 5, physicians who participate in Medicare must include their names and National Provider Identifiers, or NPIs, when ordering prescriptions, medical supplies or medical services or when making patient referrals for service. And enrollment in Medicare will be checked against the Medicare Provider Enrollment, Chain and Ownership System, PECOS.
According to an article in CMS' MLN Matters (4-page PDF; About PDFs), Medicare claims that lack the proper information will continue to be processed if they are received by Jan. 3. However, the provider or supplier will receive a warning on the remittance advice.
The grace period ends on Jan. 4. From that point forward, Medicare claims will be rejected if the ordering physician's NPI and active status in Medicare cannot be verified.
Cynthia Hughes, C.P.C., an AAFP coding specialist, said the change likely will most affect physicians who are semi-retired or retired but who maintain prescribing privileges.
"I've heard from some of our semi-retired members recently who were asked to provide an NPI number when they prescribed medication or ordered medical supplies. These members had not attained an NPI number and may not be actively enrolled in Medicare," said Hughes.
Full story
Published: 2009-11-03 01:09:57
Author: AAFP | October 30, 2009
Effective Oct. 5, physicians who participate in Medicare must include their names and National Provider Identifiers, or NPIs, when ordering prescriptions, medical supplies or medical services or when making patient referrals for service. And enrollment in Medicare will be checked against the Medicare Provider Enrollment, Chain and Ownership System, PECOS.
According to an article in CMS' MLN Matters (4-page PDF; About PDFs), Medicare claims that lack the proper information will continue to be processed if they are received by Jan. 3. However, the provider or supplier will receive a warning on the remittance advice.
The grace period ends on Jan. 4. From that point forward, Medicare claims will be rejected if the ordering physician's NPI and active status in Medicare cannot be verified.
Cynthia Hughes, C.P.C., an AAFP coding specialist, said the change likely will most affect physicians who are semi-retired or retired but who maintain prescribing privileges.
"I've heard from some of our semi-retired members recently who were asked to provide an NPI number when they prescribed medication or ordered medical supplies. These members had not attained an NPI number and may not be actively enrolled in Medicare," said Hughes.
Full story