Tag: Medicare

MEDICARE ORDERING AND REFERRAL FILE

Posted on by DME INFO

As stated in the CMS provider listserv messages that were sent last fall concerning CRs 6417 and 6421, CMS has made available in the Downloads section of this web site a file that contains the National Provider Identifier (NPI) and the name (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is legally eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in PECOS). This is a .pdf file containing approximately 800,000 records.

 A new file will be made available periodically that will replace the posted file; at any given time, only one file (the most recent) will be available. The file can be downloaded by users with technical expertise and further sorted or manipulated. It can also be used to search for a particular physician or non-physician practitioner by NPI or by name. Please note the following: (1) Records are in alphabetical order based on the surname of the physician or non-physician practitioner. (2) Name suffixes (e.g., Jr.), if they exist, are not displayed. (3) There are no “duplicates” in the file. Many physicians or non-physician practitioners share the same first and last name; their corresponding NPIs are the assurance of uniqueness. (4) Deceased physicians and non-physician practitioners are not included in the file. 

Please click here for the source of this post and access to the Medicare Ordering and Referral File   

A Message of Interest to Physicians and Non-Physician Practitioners Regarding NPI and Enrollment Files

Posted on by DME INFO

Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and also contains the physician/non-physician practitioner’s National Provider Identifier (NPI). Under Phase 2 of the above referenced CRs, a physician or non-physician practitioner who orders or refers and who does not have a current enrollment record that contains the NPI will cause the claim submitted by the Part B provider/supplier who furnished the ordered or referred item or service to be rejected.

CMS continues to urge physicians and non-physician practitioners who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003 to update their enrollment record now. If these physicians and non-physician practitioners have no changes to their enrollment data, they need to submit an initial enrollment application which will establish a current enrollment record in PECOS.

Please click here for the source of this post and additional  information

HCPCS Code Update – 2010

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For more information, please click above on the title of this post, then click this link CODE UPDATES

 

HCPCS Code Update – 2010

The following list identifies changes to level II Healthcare Common Procedure Coding System (HCPCS) codes for 2010.

Added Codes/Added Modifiers: New codes and modifiers are effective for dates of service on or after January 1, 2010.

Discontinued Codes/Deleted Modifiers: Codes or modifiers that are discontinued/deleted will continue to be valid for claims with dates of service on or before December 31, 2009, regardless of the date of claim submission. If there is a direct crosswalk for a discontinued/deleted code or modifier, it is listed in the table. The crosswalked codes are also “added” codes effective for dates of service on or after January 1, 2010.

There is no grace period that would allow submission of the discontinued code for dates of service in 2010.

Narrative Changes/Revised Modifiers: A description change for an existing code or modifier is effective for dates of service on or after January 1, 2010.

The following codes are being deleted from the HCPCS effective January 1, 2010, and are therefore being removed from the DMEPOS fee schedule files

Posted on by DME INFO

For more information, please click above on the title of this post, then click this link DELETED CODES

The following codes are being deleted from the HCPCS effective January 1, 2010, and are therefore being removed from the DMEPOS fee schedule files

Knee Orthoses—Prepayment Review Update

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For more information, please click above on the title of this post, then click the link  For additional information

The National Government Services Jurisdiction B Medical Review Department recently conducted a prepayment targeted medical review of Knee Orthoses. This is a widespread random selection of submitted claims based on a targeted service(s) from multiple suppliers which are reviewed for medical necessity.