Mid-Atlantic Health Law TOPICS

Medicare Referrers: Did you know that beginning in 2011, all providers that order or refer services to be paid by Medicare must themselves be enrolled in Medicare? Suppliers that bill Medicare for a referred or ordered service or item must include the name and unique identifier of the ordering or referring provider. Since October 2009, each Multi-Carrier System (MCS) has been required to verify that the provider listed as the referring or ordering provider is listed in either CMS's Provider Enrollment, Chain and Ownership System (PECOS) or the contractor's master provider file. For claims received after January 3, 2011, the MCS will not pay the claim, if the ordering or referring provider is not listed in PECOS or the contractor's provider file.

DME: Did you know that the Office of Inspector General (OIG) recently issued a Fraud Alert on telemarketing by durable medical equipment (DME) suppliers? The Alert states that DME suppliers may not make (or contract with a marketing firm to make) unsolicited calls to Medicare beneficiaries regarding the furnishing of DME, unless the beneficiary has given written permission for suppliers to contact the beneficiary by telephone, or if the beneficiary has received a covered item from the supplier in the last 15 months. The DME supplier may contact the beneficiary about an item already received by the beneficiary, or about an item that has been prescribed by a physician, and about which the physician has contacted the supplier with the beneficiary's permission.

MRI, CT and PET Accreditation: Did you know that the Medicare Improvements for Patients and Providers Act of 2008 requires all non-hospital based suppliers of advanced diagnostic imaging services, including MRI, CT and PET, to be accredited by January 1, 2012, to qualify to provide services to Medicare beneficiaries? CMS has selected three accreditation organizations - the American College of Radiology, the Intersocietal Accreditation Commission and the Joint Commission.