Part B Insider (Multispecialty) Coding Alert

If your practice put phase two of the Medicare ordering and referring edits on the back burner since CMS has delayed it so many times, you may want to turn your attention back to the subject. CMS announced on Nov. 6 that the edits will kick in on Jan. 6, 2014.

“Effective January 6, 2014, CMS will turn on the edits to deny Part B clinical laboratory and imaging, DME, and Part A HHA claims that fail the ordering/referring provider edits,” CMS says in MLN Matters article SE1305. “Claims submitted identifying an ordering/referring provider and the required matching NPI is missing will be rejected.”

For those of you keeping score at home, it has now been over three years that CMS has delayed 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, just before May 1, CMS pushed it back again, and now January is the updated date.

To read the complete article on the new phase two edit date, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdf.