CMS Delays Plan to Deny Non-Enrollees' Medicare Claims

Technical issues have delayed plans by the Centers for Medicare & Medicaid Services (CMS) to begin denying claims for services ordered or referred by a physician who is not enrolled in Medicare. The denials were scheduled for May 1. CMS did not elaborate on the technical issues or set a new deadline.

Physicians should monitor the Ordering & Referring Information page on the CMS website for updates.

Once CMS solves its technical issues, physicians who receive claim denials will need to contact the ordering or referring physician to verify that he or she has enrolled in Medicare to prevent future denials. You can use TMA's free tool to check your Medicare ordering and referring status.

CMS still urges physicians who order such services and are not enrolled to do so immediately, or the applications may not be processed before May 1.

Physicians who have opted out of Medicare can order items or services for Medicare beneficiaries by submitting an opt-out affidavit to Novitas Solutions, the Texas Medicare claims administrator. The opt-out information must be current: An affidavit must be completed every two years, and the physician's National Provider Identifier (NPI) is required on the affidavit.

The American Medical Association and the Medical Group Management Association developed a list of frequently asked questions and answers about the change.

If you are reconsidering your Medicare participation status, TMA offers a webinar on physicians' Medicare participation options.


Action, May 1, 2013


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