Part B Insider (Multispecialty) Coding Alert
CMS Sets Jan. 6 as Ordering/Referring Edit Implementation Date
PDF
If your practice put phase two of the Medicare ordering and referring edits on the back burner since CMS has delayed it so many times, you may want to turn your attention back to the subject. CMS announced on Nov. 6 that the edits will kick in on Jan. 6, 2014.
“Effective January 6, 2014, CMS will turn on the edits to deny Part B clinical laboratory and imaging, DME, and Part A HHA claims that fail the ordering/referring provider edits,” CMS says in MLN Matters article SE1305. “Claims submitted identifying an ordering/referring provider and the required matching NPI is missing will be rejected.”
For those of you keeping score at home, it has now been over three years that CMS has delayed phase two of the ordering/referring edits. The agency was initially shooting for a Jan. 4, 2010 implementation date, but pushed it back indefinitely before that date. Then in July of 2012, CMS announced the PECOS denials would begin “soon,” followed by a firm date of May 1, 2013 earlier this year. However, just before May 1, CMS pushed it back again, and now January is the updated date.
To read the complete article on the new phase two edit date, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdf.
Part B Insider (Multispecialty) Coding Alert
- Pulmonary Coding:
Collect for Your Pulmonary Education Services With These 5 Tips
Inhaler demo could pay you $19 — if you know how to navigate the rules. [...] - ICD-10:
J45 Shifts Focus to Severity for Asthma Reporting
Hint: Identify symptoms and medication use for accurate reporting. Asthma is a common condition that [...] - Medicare Drug Screens:
G0431, G0434 Define Your Options
Steer clear of the 80100 series for this payer. If you’re reporting drug screening tests [...] - Reader Question:
Rereads May Not Warrant Recharges
Question: When one pathologist in our practice asks another pathologist in our practice to “reread” [...] - Reader Question:
Check Records to Nail Down Laryngoscopy Code
Question: Our physician recently performed a laryngoscopy during which he removed a foreign body. As [...] - Reader Question:
Get to Know Modifiers ZA and ZC
Question: Do you have any information on the correct use of modifiers ZA and ZC? [...] - Reader Question:
Arteriography Offers Several Options
Question: My doctor performed LHC, aortic root arteriography with runoff, and a bilateral renal arteriogram. [...] - Reader Question:
Know the Rules for Add-ons
Question: Our physician recently performed the infusion of two anti-neoplastic substances for a patient. I [...] - Physician Notes:
CMS Sets Jan. 6 as Ordering/Referring Edit Implementation Date
If your practice put phase two of the Medicare ordering and referring edits on the [...]