Although the regulation requiring that only Medicare enrolled physicians or eligible professionals order and refer certain items and services, such as DME and home health, was effective July 1, 2010, CMS has stated that it will not automatically reject claims based on orders/referrals from providers who have not yet had their applications approved. MLN Matters Article 6421 states the edits will go into effect on January 3, 2011. All this being said; it is critical to note that the rule has not been suspended. Providers should not submit claims for services related to providers they know are not enrolled. Doing so could have serious compliance implications.
CMS has an Ordering Referring Report that can be accessed to determine if an ordering/referring provider is enrolled in PECOS. To view this report, go to: http://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp#TopOfPage
CMS also has provided a new Initial Physician and Non-Physician Applications Pending Contractor Review File. Providers can access this file to see if a provider’s application is in process and pending contractor review. While the applications have NOT been processed and approved, provider’s can at least verify that an application has been submitted and is awaiting processing. To view this file, go to: http://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp#TopOfPage
Guidance has also been issued for providers that infrequently receive reimbursement from the Medicare program. This can also be found at: http://www.cms.gov/MedicareProviderSupEnroll/
