Medicare Compliance & Reimbursement

Check that your claims include the required ordering physician ID number. Starting Oct. 5, intermediaries and carriers will begin Phase 1 of the physician ID edit -- which means you'd better double check details. They will still process a claim when an ordering doc's National Provider Identifier (NPI) number isn't in the PECOS or contractor file, the Centers for Medicare & Medicaid Services explains in Transmittal No. 510 (CR 6417), reissued June 26. But the claim will carry a new remark code: "M68 (missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification)." When CMS begins Phase 2 of the project, which doesn't yet have a start date, that claim without a valid physician NPI will get rejected, CMS notes in a related MLN Matters article at www.cms.hhs.gov/MLNMatters/Aticles/downloads/MM6417.pdf. The reissued transmittal is at www.cms.hhs.gov/transmittals/downloads/R510OTN.pdf.