Part B Insider (Multispecialty) Coding Alert

In other news…

Medicare contractors are bound to deactivate providers' enrollment records if they've had no claims activity during a 12 consecutive month period, which created a bit of a quandary for those providers who have recently enrolled in Medicare just so they can order and refer services. CMS seems to have solved that problem with new MLN Matters article SE1034, which notes that "CMS excludes certain physicians and NPPs from this deactivation process and has instructed Medicare contractors accordingly."

The following providers will be excluded from the 12-month deactivation requirement if they enroll "for the sole purpose of ordering and referring items and services for Medicare beneficiaries," the article notes:

  • Doctors of medicine or osteopathy
  • Doctor of dental medicine
  • Doctor of dental surgery
  • Doctor of podiatric medicine
  • Doctor of optometry
  • Doctor of chiropractic medicine
  • Physician assistant
  • Certified clinical nurse specialist
  • Nurse practitioner
  • Clinical psychologist
  • Certified nurse midwife
  • Clinical social worker

In addition, pediatricians and oral surgeons are excluded from the deactivation process regardless of their enrollment reason, the transmittal notes.

To read the article in its entirety, visit www.cms.gov/MLNMattersArticles/downloads/SE1034.pdf.

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