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New Medicare ordering and referring policy delayed

NEWS IN BRIEF — Posted May 6, 2013

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The enforcement of a new Medicare enrollment requirement, set for May 1, has been delayed, the Centers for Medicare & Medicaid Services announced.

Unspecified technical issues prevented the agency from implementing the system that will check and deny claims for Medicare services that are not in compliance with new billing rules. Claims-processing edits will verify the validity of physicians and other professionals ordering or referring medical services to ensure that they have enrollment records and national provider identifiers. Claims involving those not in the CMS system or without valid NPIs will be rejected.

The fraud prevention measure is limited to claims for laboratory, imaging and equipment services. Services involving referrals to specialists are exempt, but physicians ordering other services and medical items must have valid enrollment records and NPIs.

CMS will advise physicians and health professionals when the claims edits will be turned on in the near future, the agency said.

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