Oncology & Hematology Coding Alert

You have a little more time to verify that providers are eligible to order Medicare tests.

CMS has announced that “Due to technical issues, implementation of the Phase 2 ordering and referring denial edits is being delayed.”

This announcement came less than a week before the planned May 1 implementation, which would have triggered denials for certain claims. These included Part B claims from labs and imaging centers if the ordering provider was not appropriately listed or was not eligible to order the service. A new implementation date has not yet been declared.

You can read the announcement at www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2013-04-25Enews.pdf.

Additional info: To learn more about the edits, read MLN Matters SE1305 (www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/se1305.pdf). Note that the article was revised April 19 to add that only the technical component is subject to the ordering provider edit. The professional component will be excluded from the edits, but “if billing globally, both components will be impacted by the edits and the entire claim will deny if it doesn’t meet the ordering and referring requirements. It is recommended that providers and suppliers bill the global claims separately to prevent a denial for the professional component.”

The imaging suppliers specifically listed as covered by the requirement include independent diagnostic testing facilities, mammogram centers, portable X-ray facilities, and radiation therapy centers.

You’ll find similar details in the supplementary information with 42 CFR Parts 424 and 431, page 25291, of “Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements,” available at www.gpo.gov/fdsys/pkg/FR-2012-04-27/pdf/2012-9994.pdf