Anesthesia Billing: Referring Provider Edits Delayed
Anesthesia and Pain practices can breath a sigh of relief. The referring provider claims edits scheduled to go into effect on January 1, 2011 have been delayed until July 5th.
Anesthesiologists and CRNAs who order or refer services for Medicare beneficiaries must be enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and must be of a type/specialty that is eligible to order/refer services for Medicare beneficiaries. The new implementation date for Phase 2 is being delayed and will not begin on January 3, 2011. A placeholder date of July 5, 2011 has been stated in the revised CR 6417.
Can you confirm for me that CRNA’s are not “of a type or specialty eligible to order /refer services for Medicare Beneficiaries” based on CMS Transmittan # 642. They were excluded from the list of providers who can orde/refer.
Thank you.
Karen Prescott
Anestehsia Practice Director
EMMC
Bangor, Maine
Karen,
In discussions with the CMS intermediaries, I have been told that CRNAs fall under the “Certified Clinical Nurse Specialist” (listed on the MLN Matters Number: 6417). I was also advised to verify that each CRNA is listed on the PECOs system by downloading the Medicare Ordering and Referring Report and then perform a search on the provider’s NPI number. I have done this for all of the CRNA providers that we manage. Here is the link to the Medicare Orderring and Referring Report. Be patient it is a huge file and takes a few minutes to download. Hope this helps. Robert
https://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp