$alert = array(); $alert[Title] = "CMS Medicare Expands Edit for Referring & Ordering Providers"; $alert[Date] = "08/05/2009"; $alert[Html] = "CMS is expanding their editing process for referring/ordering providers reported on Medicare claims beginning October 1, 2009.\n\nCMS will perform verification that provider is enrolled in Medicare and eligible to order or refer Medicare services. Provider claims that do not meet this standard will process with the following message on their remittance advice:\n\nM68 – missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification\n\nANSI 837P Claims: \n\n2310A/2420F(referring) NM101-NM105 \n\n2420E (ordering) NM101-NM105\n\nPrint Image Claims: \n\n Boxes 17 & 17b\n\nThe following services/situations require the submission of the referring/ordering provider information: \n\n\n• Medicare-covered services and items that are the result of a physician’s order or referral. \n\n• Parenteral and enteral nutrition. \n\n• Immunosuppressive drug claims. \n\n• Hepatitis B claims. \n\n• Diagnostic laboratory services. \n\n• Diagnostic radiology service. \n\n• Portable X-ray services. \n\n• Consultative services. \n\n• Durable medical equipment. \n\n• When the ordering physician is also the performing physician (as often is the case with in-office clinical laboratory tests). \n\n• When a service is “incident to” the service of a physician or-non-physician practitioner, the name of the physician or non-physician practitioner who performs the initial service and orders the non-physician service must appear in Item 17. \n\n• When a physician extender or other limited licensed practitioner refers a patient for consultative service, submit the name and NPI of the physician who is supervising the limited licensed practitioner. \n\nOnly the following provider specialties can order or refer beneficiary services: \n\n• Doctor of Medicine or Osteopathy; \n• Dental Medicine; \n• Dental Surgery; \n• Podiatric Medicine; \n• Optometrist; \n• Chiropractic Medicine; \n• Physician Assistant; \n• Certified Clinical Nurse Specialist; \n• Nurse Practitioner; \n• Clinical Psychologist; \n• Certified Nurse Midwife; or \n• Clinical Social Worker. \n"; $alert[Action] = "Please visit the link below for complete impact statement and CMS policy information.\nhttp://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6417.pdf\n"; ?> if ($alert[Action] == "") $alert[Action]="No action required by provider."; $alert[Html] = str_replace( "\n\n", "
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$alert[Action] = str_replace( "\n", "
", $alert[Action]); ?> if (!$alert[Preview]) echo("