Medicare Requirement for NPI of Referring Physicians
Medicare through its PECOS enrollment records will begin denying claims from providers where the referring physician /practitioner name and NPI are not in their database. Starting Jan. 4, 2010, CMS will begin rejecting claims that include the names and NPI numbers of physicians and non-physician practitioners that aren't listed in the system. Last month, the agency began sending providers "informational messages"-not denials-to alert them of such claims.
The bulletin states that CMS is taking the following actions to reduce the number of informational messages prior to Jan. 4:
· CMS will systematically add to the PECOS enrollment records the NPIs of all physicians and non-physician practitioners whose PECOS records do not contain their NPIs. This action will result in the addition of many more physicians and non-physician practitioners to the PECOS list.
· CMS will make publicly available on the Internet a national file of Medicare physicians and non-physician practitioners who are eligible to order/refer. The file will contain the NPI and the legal name (from the Medicare PECOS enrollment record). This will allow DMEPOS suppliers to determine if the ordering/referring provider has a current Medicare enrollment record and is eligible to order or refer.
· An MLN Matters article (MM6421) about CR 6421 is available on the CMS Web site (Search for MM6421 at http://www.cms.hhs.gov/MLNMattersArticles/2009MMAN/list.asp#TopOfPage
). To supplement that article, CMS will be preparing a Special Edition Medicare Learning Network (MLN) Matters article.
· CMS's Medicare contractors have also initiated a revalidation effort (via CR 6574, Transmittal 557), which is designed to update the Medicare enrollment record for 2,500 physicians and non-physician practitioners (50 practitioners per state). We expect that this revalidation effort will be complete or nearing completion by Jan. 4.