Medicare is finally implementing new rules that will target physicians who order or refer items and services for their Medicare patients but who lack proper identification.
Effective Jan. 6, 2014, Medicare contractors will implement specific edits that will restrict suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) from receiving payment from Medicare for items that physicians have prescribed if they do not have a current enrollment in the Medicare Provider Enrollment, Chain and Ownership System (PECOS).
The second phase of denial edits was originally supposed to go into effect last May, but they were delayed by technical issues and the new date announced in December.
For any DMEPOS item to qualify for Medicare coverage, it must be ordered by a physician or a practitioner who:
• is enrolled in PECOS,
• is registered in the system, and
• has a specialty that is eligible to order DMEPOS items for Medicare beneficiaries.
The provider specialties who can order DMEPOS items include:
• Doctor of Medicine or Osteopathy
• Doctor of Dental Medicine or Dental Surgery
• Doctor of Podiatric Medicine
• Physician Assistant
• Certified Clinical Nurse Specialist
• Nurse Practitioner
• Doctor of Optometry
Physicians can help the DMEPOS suppliers with whom they work by promptly enrolling in PECOS, or by updating their existing Medicare enrollment information. To continue to order DMEPOS for Medicare beneficiaries, physicians will have to enroll in the Medicare program or “revalidate” their Medicare enrollment information. To do so, either use the Internet-based PECOS, or fill out the appropriate Medicare provider enrollment application(s) and mail it, along with any required information, to the local Medicare carrier or A/B Medicare Administrative Contractor (MAC) for processing.
You can confirm if you are currently enrolled in Medicare by contacting your designated enrollment contractor or by viewing your enrollment record online on PECOS. If you have a PECOS record, make sure it includes your National Provider Identifier (NPI) and update your record if it doesn't. You can also download the Medicare Ordering and Referring file and see if your NPI is listed.
For additional information, contact your local A/B MAC.
– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians
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