Part B Insider (Multispecialty) Coding Alert
Ready for Ordering/Referring Edits? CMS Is Not
Plus: Auditors accuse CIGNA of overbilling Medicare by $28 million.
Part B practices have been scrambling to prepare for phase two of the Medicare ordering and referring edits, which were supposed to kick in on May 1. However, although MACs have been scrambling to prep as well, CMS was not ready in time to begin implementation.
"Due to technical issues, implementation of the Phase 2 ordering and referring denial edits is being delayed," CMS said in an April 25 statement. "CMS will advise you of the new implementation date in the near future," CMS continued. "In the interim, informational edits will continue to be sent for those claims that would have been denied had the edits been in place."
For those of you keeping score at home, it has now been over three years that CMS has been delaying phase two of the ordering/referring edits. The agency was initially shooting for a Jan. 4, 2010 implementation date, but pushed it back indefinitely before that date. Then in July of 2012, CMS announced the PECOS denials would begin "soon," followed by a firm date of May 1, 2013 earlier this year. However, it looks like that date will be pushed back once more.
To read the complete CMS announcement on the delay, visit www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2013-04-25Enews.pdf
Part B Insider (Multispecialty) Coding Alert
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