CMS delays Medicare Phase 2 ordering/referring requirement
The Centers for Medicare & Medicaid Services (CMS) recently announced that it is delaying Phase 2 of the Medicare ordering/referring edits, which were scheduled to go into effect today, May 1. CMS cited technical issues as the cause of the delay, and the agency will announce a new implementation date in the near future.
These requirements apply to ordered or certified items and services including DMEPOS, clinical laboratory and imaging services, and home health claims billed by Medicare Part B suppliers. As part of these requirements, an ordering or certifying provider must have an enrollment record in Medicare, must be of a specialty that is eligible to order/certify in Medicare, and that physician's legal name and national provider identifier must be listed on the claim. It is important for practices to understand the criteria and to look for the warnings that are currently being used to avoid future claims denials.