Dear Physicians Letter

Dear Physician:

The Centers for Medicare and Medicaid Services (CMS) are expanding claim edits for ordering/referring providers of Medicare Part B clinical laboratory and imaging, Durable Medical Equipment (DME), and Part A Home Health Agency (HHA) claims. Effective January 6, 2014, implementation of specific edits will occur that will restrict payment from Medicare for items that you have prescribed if you do not have a current enrollment in the Medicare Provider Enrollment, Chain and Ownership System (PECOS). Help your partners who provide lab, imaging, DME, and HHA services to continue providing quality services to your Medicare patients by promptly enrolling in PECOS, or by updating your existing Medicare enrollment information if you have not done so recently.
For clinical laboratory, imaging, DME and HHA services to qualify for coverage by Medicare, they must be ordered by a physician or a practitioner who is eligible to order such items. To be eligible physicians or practitioners must:

  • Enroll in PECOS
  • Have a specialty that is eligible to order DME Prosthetics Orthotics & Supplies (DMEPOS) items for Medicare beneficiaries.

Only physicians and certain types of non-physician practitioners are eligible to order or refer items or services for Medicare beneficiaries. They are as follows; however, limitations are defined within the CMS MLN Matters SE1305 (Revised):

  • Physicians (Doctor of Medicine or Osteopathy, Doctor of Dental Medicine, Doctor of Dental Surgery, Doctor of Podiatric Medicine, Doctor of Optometry. NOTE: Optometrists may only order and refer DMEPOS products/services and laboratory and X-ray services payable under Medicare Part B.)
  • Physician Assistants
  • Clinical Nurse Specialists
  • Nurse Practitioners
  • Clinical Psychologists
  • Interns, Residents, and Fellows
  • Certified Nurse Midwives
  • Clinical Social Workers

In order to continue to order the described services for Medicare beneficiaries, you will have to enroll in the Medicare program or "revalidate" your Medicare enrollment information. You may do so by:

  • Using Internet-based PECOS
  • Complete the appropriate Medicare provider enrollment application(s) and attach any required documentation and send to your A/B Medicare Administrative Contractor (MAC), who will enter your information into PECOS and process the application

To confirm you have a current enrollment record, contact your designated enrollment contractor or use the Internet-based PECOS to view your enrollment record. If you have a PECOS record, ensure that your NPI is on file and all other information is current.

For additional information please contact your A/B MAC.

Sincerely,

Gary Oakes, MD
Noridian, LLC - Jurisdiction E and F
900 42nd Street S
P.O. Box 6781
Fargo, ND 58108-6781

Arthur Lurvey, MD, FACP, FACE
Noridian, LLC - Jurisdiction E and F
900 42nd Street S
PO Box 6781
Fargo, ND 58108-6781

Eileen Moynihan, MD, FACP, MACRh
Noridian, LLC - Jurisdiction E and F
900 42nd Street S
PO Box 6781
Fargo, ND 58108-6781

Larry Clark, MD, FACP
Noridian, LLC - Jurisdiction E and F
900 42nd Street S
PO Box 6781
Fargo, ND 58108-6781

Janet Lawrence, MD, MS, FACP
Noridian, LLC - Jurisdiction E and F
900 42nd Street S
PO Box 6781
Fargo, ND 58108-6781

Ann Marie Sun, MD
Noridian, LLC - Jurisdiction E and F
900 42nd Street S
PO Box 6781
Fargo, ND 58108-6781

Raeann Capehart, MD
Noridian, LLC - Jurisdiction E and F
900 42nd Street S
PO Box 6781
Fargo, ND 58108-6781

 

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