Medicare E-Newletter Notice

Medicare E-Newletter Notice

Wil Haines

11/8/2013

*Dear Colleagues and Guests,

Seems like another round is on the horizon. First, unless something has
changed, if box 18??? or whatever it is that determines if a physician
or other approved healthcare provided is not checked specifically for
O&P services, then claims will be denied and suppliers will be liable
for the consequences. To my knowledge, this is still a little known
hidden secret and is very difficult to find. The PECOS list, in and of
itself, does not ensure that suppliers will be paid for O&P services
rendered. If I am wrong about this, I stand corrected.

Also, as you can see below optometrists will also be eligible to provide
DMEPOS services and there is no mention of restrictions to eye related
devices.
As of this date, implied is not in the Medicare/CMS vocabulary.

Below are excerpts from the latest Medicare E Newsletter.

Hope it helps.

Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123

..........................Claims submitted identifying an
ordering/referring provider and the required matching NPI is missing
will continue to be rejected. *
*Claims from billing providers and suppliers that are denied because
they failed the ordering/referring edit will not expose a
Medicare beneficiary to liability. Therefore,an Advance Beneficiary
Notice is not appropriate in this situation. This is consistent
with the preamble to the final rule which implements the Affordable Care
Act requirement that physicians and eligible *
*professionals enroll in Medicare to order and certify certain Medicare
covered items and services, including home health, DMEPOS,
**imaging and clinical laboratory......................................**
**
*
*....................Physicians and others who are eligible to order and
refer items or services need to establish theirMedicare enrollment
record and must be of a specialty that is eligible to order and refer.
Physicians and others who are eligible to order and refer items
*
*or services need to establish their Medicare enrollment record with a
valid NPI and must be of a specialty that is eligible to order
and refer. If the ordering/referring provider is listed on the claim,
the edits will verify that the provider is enrolled in Medicare.
The edits will compare the first four letters of the last
name.........................................*
*
*
*.....................Optometrists may only order and refer DMEPO S
products/services and laboratory and X-Ray**services payable under
Medicare Part B.*........................................................