CMS announces January implementation of ordering/referring provider edits
American Academy of Sleep Medicine
Thursday, November 21, 2013
In March, the AASM reported that the Centers for Medicare & Medicaid Services (CMS) planned to implement edits resulting in claims denial if the ordering or referring provider is not enrolled in Medicare. The edits were originally to be implemented in May 2013 but were delayed. Recently, CMS announced a new implementation date of Jan. 6, 2014.
The new CMS program requires that providers be enrolled in Medicare to order or refer items or services to Medicare beneficiaries. Providers who are not currently enrolled in Medicare are encouraged to do so via the Provider Enrollment, Chain and Ownership System (PECOS). Claims for services ordered or referred by a non-enrolled provider will be denied following the Jan. 6, 2014 implementation date.