tci Part B Insider - 2013 Issue 9

Denial Management: CMS Confirms Ordering/Referring Edits Will Start May 1

Ensure that your doctors and those who order/refer are the correct specialty and that you have their NPIs on file. Starting May 1, you could get a mountain of denials if you haven’t been prepping for Medicare’s ordering/referring edits. 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 could be rejected. CMS recently confirmed that these denials will begin on May 1, according to MLN Matters article SE1305. CMS had previously hinted at a May 1...

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