Part B Insider (Multispecialty) Coding Alert

Published on Fri Mar 01, 2013 PDF

Plus: Want your say on the new diagnosis changes? Join CMS’s latest seminar.

Part B practices have been waiting patiently for an official word regarding when CMS will turn on the ordering/referring edits, at which point claims without an ordering/referring physician’s NPI will could be rejected. A recently released—and quickly rescinded—MLN Matters article on the topic suggests that the date could be right around the corner.

On Feb. 25, CMS released MLN Matters article SE1305, which said, “Effective May 1, 2013, CMS will turn on the Phase 2 denial edits. This means that Medicare will deny claims for services or supplies that require an ordering/referring provider to be identified and that provider is not identified, is not in Medicare’s enrollment records, or is not of a specialty type that may order/refer the service/item being billed.”

However, just as soon as the article hit inboxes, CMS removed it from its Web site and emailed a separate message saying “SE1305 was erroneously sent out yesterday and has since been rescinded. This article will be re-submitted when ready.”

As of press time, Part B MAC NGS Medicare still had the article on its site at http://www.ngsmedicare.com/wps/wcm/connect/516be9804eb21a80a72abf79abff8e81/SE1305.pdf?MOD=AJPERES&CACHEID=516be9804eb21a80a72abf79abff8e81. It’s unclear at this point whether the date is not accurate, other information in the article was incorrect, or CMS was just not ready to make the announcement. Keep an eye on the Insider for more as CMS releases additional details about this situation.