CMS publishes ordering and referring final rule

On April 27, the Centers for Medicare & Medicaid Services (CMS) published a final rule on Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements. 

The rule, which is effective June 26, sets requirements for physicians who order or certify imaging services, clinical laboratory services, DMEPOS or home health services for Medicare beneficiaries.

To order or certify these services for Medicare patients, physicians must:

  • Enroll or verify enrollment in Medicare via PECOS or paper enrollment applications;
  • Retain records related to orders and certifications for 7 years either electronically or on paper; and 
  • Use their Type I individual National Provider Identifier (NPI) when ordering or certifying, even if they are typically reimbursed under a Type II NPI.

Members are encouraged to visit the Medicare Provider-Supplier Enrollment website to enroll or verify enrollment in order to comply with this final rule.  For additional information about obtaining an NPI, visit the CMS NPI website

2012-05-04T00:00:00+00:00 May 4th, 2012|Clinical Resources|