Reporting of Ordering Physician NPI Required by May 23

Reporting of Ordering Physician NPI Required by May 23 Submission of an NPI number for the ordering or referring physician on a Medicare claim form will be mandatory effective May 23, 2008, whether or not the provider participates in the Medicare program. The rationale offered by Centers for Medicare and Medicaid Services (CMS) is that the provider who submits the claim is responsible for obtaining the referring provider's NPI number. CMS is instructing providers to use their own name and NPI in the referring/ordering physician field of the claim when they are unable to obtain the NPI after several...

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Note:  The following article synopsis was NOT provided by the AMA. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains a Medicare administrative update affecting claim submission for ordering or referring physician information, including timing, compliance expectations, and how CMS guidance changed from earlier legacy identifier practices. It is relevant to billing staff, coders, compliance teams, and practices that submit Medicare claims and need to stay current with CMS reporting requirements.

Why This Topic Matters

Claims processing can be delayed or rejected if required physician identifier information is not reported correctly, so this update helps practices understand a Medicare compliance change and its operational impact.

What You Will Learn

  • The Medicare claim reporting change described in the article
  • The compliance timeline referenced by CMS
  • The general claim submission issue involving ordering or referring physician information
  • Where the article directs readers for additional CMS guidance

Who Should Read This

  • Medical coders
  • Billing staff
  • Revenue cycle personnel
  • Compliance teams
  • Physician practices
  • Radiology billing professionals

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