Archive for April, 2012

CMS Releases Medicare “Final Rule”

On April 24, 2012, the Centers for Medicare & Medicaid Services (CMS) released the final rule detailing requirements for ordering and referring in Medicare. In 2009, CMS began issuing warnings for Medicare claims that failed to meet CMS’s ordering and referring criteria, including requiring the ordering/referring provider have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS). An interim final rule released in 2010 further detailed these ordering and referring requirements.

The final rule released yesterday includes changes to some of the previous requirements.  CMS changed the regulatory language from requiring an enrollment in PECOS to requiring enrollment in Medicare — including PECOS or other legacy Medicare enrollment systems. Additionally, CMS removed specialist services from those that are required to list the ordering or certifying provider on the claim and meet the other criteria. This change resulted in CMS replacing the term “refer” with “certify” for the applicable items and services. The requirements in this final rule apply to ordered or certified items and services including DMEPOS, clinical laboratory and imaging services, and home health claims billed by Medicare Part B suppliers. For these claims, ordering or certifying providers must be eligible to order or certify in Medicare, their legal name and NPI must be listed on the claim, and they must have an enrollment record in Medicare. The requirements vary slightly for medical interns and residents who order or certify these items and services.

CMS will continue to issue warnings for claims that fail to meet these criteria, but at this point CMS will not deny claims that do not meet the criteria. In the future, CMS will begin to deny claims, but has not indicated when this will occur.

Department of Health and Human Services Announces Proposed Date Change for ICD-10

The Department of Health and Human Services announced on April 9, 2012 a proposed administrative simplification rule which would move the ICD-10 compliance date from October 1, 2013 to October 1, 2014.

The proposed rule delays required compliance for new codes used to classify diseases and health problems.  These codes, known as the Internal Classification of Diseases, 10th Edition diagnosis and procedures codes, or ICD-10, will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.

Many provider groups have expressed serious concerns about their ability to meet the October 1, 2013 compliance date.  The proposed change to October 2014 for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.

Please click here if you would like to read more about this recent announcement.

A Message From The President

With nearly four decades of healthcare experience, Founder and President Bob Goodman shares his thoughts about what differentiates MPM from the competition.


You can also click here to download the video in Windows Media Video (WMV) format to view directly from your PC.