Medicare Enrollment Requirement Extends to EPs Who Order/Refer

Physicians and non-physician practitioners (NPPs) who order and refer items and services for Medicare beneficiaries—even if that’s all they do— must be enrolled in the Medicare program, according to the Centers for Medicare & Medicaid Services (CMS). The government agency announced recently that it is implementing this requirement as it appears in the Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements Interim Final Rule.

Effective Oct. 18, physicians and NPPs who order or refer items or services for Medicare beneficiaries and who are (1) employed by the Department of Veterans Affairs (DVA), the Public Health Service (PHS), the Department of Defense (DOD) TRICARE; or by a Medicare enrolled Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC) or Critical Access Hospital (CAH); (2) in a fellowship; or (3) a dentist or oral surgeon will need to enroll in the Medicare  program. A modified enrollment process is described in MLN Matters article MM7097, issued Sept. 17.

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