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ODs must list own names as ordering/referring providers on Medicare claims May 1

March 4, 2013

Optometrists must use their own names and National Provider Identifiers (NPIs) on Medicare claims beginning May 1. The U.S. Centers for Medicare & Medicaid Services (CMS) announced it will deny claims for services or supplies that require an ordering/referring provider to be identified, if that provider is not identified, is not in Medicare’s enrollment records, or is not of a specialty type that may order/refer the service/item being billed.

Practitioners should put their own names and NPIs on line 17 (“Name of referring provider or other source”) of the CMS 1500 form even if they are both ordering and performing the product or service on the claim.

For additional information, see Medicare Learning Network article SE1305, “Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims” (http://tinyurl.com/MLNSE1305).

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