Physicians who refer or order services for Medicare beneficiaries must be enrolled with Medicare by January 6, 2014. Medicare contractors have been instructed to turn on ordering/referring physician edits on that date, and claims submitted on or after January 6 will be denied if the ordering/referring physician does not have an enrollment record.

The Centers for Medicare and Medicaid Services (CMS) began notifying ordering/referring physicians of the need to enroll in Medicare in October 2009. Enrollments can be completed via the online Provider Enrollment, Chain, and Ownership System (PECOS) or by completing a paper enrollment application (applicable CMS-855).

CMS had originally intended to turn on the edits last May, but the agency delayed implementation because of technical issues.

Physicians can confirm whether a referring or ordering physician is enrolled by downloading a report of all the eligible physicians and nonphysician practitioners who have current enrollment records from the CMS website. The report is updated weekly.

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Contact: Michele Kelly, (213) 226-0338 or mkelly@cmadocs.org.