Thursday, November 7, 2013
Phase 2 Medicare Ordering & Referral Denial Edits
If you haven't heard, or not aware... Medicare put this out yesterday, These denial edits will affect both Part A and Part B -- L : )
MLN Connects - Provider eNews - Medicare Learning Network
Wednesday, November 6, 2013
Ordering and Referring Denial Edits Will Be Implemented on January 6, 2014
CMS will instruct contractors to turn on Phase 2 denial edits on January 6, 2014. These edits will check the following claims for a valid individual National Provider Identifier (NPI) and deny the claim when this information is invalid:
Claims from clinical laboratories for ordered tests;
Claims from imaging centers for ordered imaging procedures;
Claims from suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for ordered DMEPOS; and
Claims from Part A Home Health Agencies (HHAs).
For more information:
MLN Matters® Article #SE1305, “Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856)”
For More information... click this link
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdf
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