Ordering and Referring Initiative - Will Phase 2 Begin January 6th?


To complete a two-phase initiative that began in 2009, CMS again announced its intent to implement the Phase 2 claims edits, which would result in claim denials if the ordering or referring physician or nonphysician practitioner does not have an enrollment record in PECOS or has not validly opted out of Medicare. In a revised Medicare Learning Network Matters publication [PDF], CMS confirmed the January 6, 2014 implementation date.

Providers and suppliers may be skeptical that Phase 2 will really begin as announced, as there has been a series of postponements since the initial implementation date some time ago. Much of the delay, however, was due to the workload of the Medicare Administrative Contractors in processing enrollment forms for physicians and nonphysician practitioners who had not previously had an enrollment record in PECOS. Processing of these applications has been a priority and implementation may well go forward as announced.

For more information about the two-phase claims edit initiative, refer to our March 21, 2013 Payment Matters article.

Written by:

Published In:

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Ober|Kaler | Attorney Advertising

Don't miss a thing! Build a custom news brief:

Read fresh new writing on compliance, cybersecurity, Dodd-Frank, whistleblowers, social media, hiring & firing, patent reform, the NLRB, Obamacare, the SEC…

…or whatever matters the most to you. Follow authors, firms, and topics on JD Supra.

Create your news brief now - it's free and easy »

All the intelligence you need, in one easy email:

Great! Your first step to building an email digest of JD Supra authors and topics. Log in with LinkedIn so we can start sending your digest...

Sign up for your custom alerts now, using LinkedIn ›

* With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name.