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.

CMS Claims Edits Delayed for Ordering/Referring Providers

The Centers for Medicare & Medicaid Services (CMS) previously announced that, beginning January 3, 2011, if certain Part B billed items and services require an ordering/referring provider and 1)the ordering/referring provider is not in the claim, 2) is not of a profession that is permitted to order/refer, or 3)does not have an enrollment record in the Medicare Provider Enrollment, Chain and Ownership System (PECOS), the claim will not be paid. The automated edits will not be turned on effective January 3, 2011. CMS commented that thry are working diligently to resolve enrollment backlogs and other system issues and will provide ample advanced notice to the provider and beneficiary communities before implementing any automatic nonpayment actions.

MLN Matters Number: SE1011; Revised Related Change Request (CR) #: 6421, 6417, and 6696; Related CR Transmittal #: R642OTN, R643OTN, and R328PI; Implementation Date: N/A