Medicare Referring/Ordering Edits Go into Effect – May 1, 2013

Ordering and referring fact sheet and FAQs_REV pdf

Medicare is preparing to go live on May 1 with the referring/ordering edits that will result in claims denials unless the referring / ordering physician or other health care provider is enrolled in Medicare (or has a valid opt-out affidavit on file with their local Medicare contractor).

 To be clear, it is the billing provider’s claim that is at risk of being denied. The AMA was instrumental in securing a delay in the implementation of this policy (which was originally scheduled to go into effect in 2010) so that physicians had sufficient time to enroll (or file a valid opt-out affidavit).

 The AMA, together with MGMA, have prepared the attached fact sheet / FAQs which your members may find helpful. For more information on Medicare enrollment please visit the AMA website at

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