Ordering and Referring Practitioner Enrollment Form

CMS recently developed a new enrollment form — the CMS 855O form — which would allow a physician or non-physician practitioner (NPP) who otherwise does not need to have Medicare billing privileges, to submit an application to obtain an enrollment record in PECOS.

Although there is still no effective date for the implementation of the policy, CMS has claims edits in place to be able to deny claims if a physician or NPP does not have an active record in PECOS, or has not validly opted out of Medicare, when order services or making a referral. This new enrollment form is only for use by physicians or NPPs that will provide orders and referrals for Medicare beneficiaries, but not for those who plan to furnish and bill for covered services.

For an overview of the final regulations related to the ordering and referring of Medicare-covered DMEPOS items and services, imaging services, clinical laboratory services, and home health services, refer to the article “Will Your Claims Survive the Automated Ordering and Referring NPI Edits?” that I wrote for Ober’s Payment Matters publication.