New Medicare Requirements

New Medicare Requirements

Jim DeWees

10/26/2009

I was notified a couple weeks ago by our clearinghouse about some changes that will take effect on Jan 1, 2010 regarding ordering or referring physicians, non-physicians practitioners, etc.

 

I don't totally understand this situation, but know that we MUST comply with this, or we will all be feeling the pain if we are not aware of this or deal with it now.

 

From what I gather, it is regarding something called PECOS, and making sure that the doctors, or whoever is signing any prescription for the patient's O&P services/devices MUST be enrolled or approved, signed up or whatever you want to call it with CMS to be authorized to sign the prescriptions for O&P.

 

From what I was told this morning by the clearinghouse, and according to their alert that went out, they are now flagging all claims that have NPI and doctor's names that are not authorized to sign these prescriptions.

 

I have a couple of claims that have been flagged with this alert, but as of now this is only kind of a warning for me, knowing that this doctor is NOT authorized to sign the Rx, and so I guess I have to call the doctor's office and inform them that they now need to update their CMS paperwork and ask about being authorized to order DME and O&P.

 

I am not sure what to tell them, or what THEY need to do, and I am not sure what kind of response that I am going to get from them.

 

I am considering writing a letter and mailing it to every referring physician that I have in my database informing them of this new policy from CMS, but again, I am not sure what to tell them other than there is some new policy and a link to the CMS website for them to go and figure out what they need to do in order to prescribe these devices and services for their patients.

 

Has anyone heard about this, and why have I not seen anything from the O&P community? Or is it out there and I missed it?? I am attathing the alert that I got from my clearinghouse, I have their approval to do this and share this with you all.

 

Thanks, and please let me know if this is something that you already know about and what you are doing about this. From the explanation I got today, if on Jan. 1, 2010 you provide something to a patient, and have the signed Rx from the doctor (which we ALWAYS have on file here), the claim will be rejected if that physician is NOT on the authorized list of referring providers. That claim will NOT be paid due to this new hoop and hurdle that is in place at that time.

 

I thought the NPI mess was the answer to this and to help ensure that these physicians were legitimate and all....what is the NPI for anyway??? Now this new process of yet another government hoop to not only make physicians have an NPI number, and a DEA number to prescribe medication...now they must also ammend their CMS contract/paperwork to get their stamp of approval to prescribe DME/O&P?? What a joke, but we must make sure of these providers before we submit the claims, or we will be killed financially if we can't get paid for our services and work.

 

Thanks again,

 

Jim DeWees, CP

 

 

Here's the copy of the alert:

 


Immediate Attention Needed
Expansion of Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplier Claims Processed by DME MACs
Reason for Notice: CMS is expanding claim editing to meet the Social Security Act Requirements for ordering and referring providers.
Attention Needed by Providers: Key Points of MedLearn, Article MM6421, state the following requirements:
1. During Phase 1 (October 5, 2009 - January 3, 2010): If the ordering/referring provider is on the claim, Medicare verifies the ordering/referring provider is MLN Matters Number: MM6421 Related Change Request Number: 6421, Page 3 of 3, in PECOS and is eligible to order/refer in Medicare.

If the ordering/referring provider is not in PECOS and is eligible to order or refer, the claim continues to process and Medicare includes an informational message on the remittance advice.
2. During Phase 2, (January 4, 2010 and thereafter): If the ordering/referring provider is not on the claim, the claim is not paid.
 
· If the ordering/referring provider is on the claim, Medicare verifies that the ordering/referring provider is in PECOS and eligible to order and refer.
 
· If the ordering/referring provider is not in PECOS, and not eligible to order and refer, the claim is not paid.
Note: In both phases, Medicare verifies the NPI and the name of the ordering/referring provider reported on the claim against PECOS.
Important Information to Remember:
• When furnishing names on the paper claims, be sure not to use periods or commas within the name. Hyphenated names are permissible.
• Providers who order, or refer, may want to verify their enrollment on the CMS PECOS site.
For more detailed information, please refer to Medlearn Article MM6421 in it's entirety by clicking the following link: MLN Matters Number: MM6421
 



 
 
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