tci Part B Insider - 2012 Issue 27

Physician Note: CMS to Start Denying Claims That Don't Meet Ordering/Referring Edits 'Soon'

Plus: Private payer partnership bolsters government's compliance efforts.If a new CMS news release is any indication, the agency might soon follow through on its longstanding threat to deny claims that fail the ordering/referring provider edits. Although CMS has had this on the horizon for several years now, the agency has never actually formalized a date when the denials would start.However, a July 26 news release indicates that CMS \"will soon begin denying Part B, DME, and Part A HHA claims that fail the ordering/referring provider edits.\" Although CMS has still not set a date, it warns...

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