Edits on the Ordering/Referring Providers in Medicare Part B, DME and Part A HHA Claims

MLN Matters® Special Edition Article #SE1011, “Edits on the Ordering/Referring Providers in Medicare Part B, DME and Part A HHA Claims (Change Requests 6417, 6421, 6696, and 6856),” was revised and is now available in downloadable format.

This article is designed to provide education on phases 1 and 2 of the edits CMS will perform on certain claims submitted by providers who order/refer services to Medicare beneficiaries. It includes a list of questions and answers related to the edits and how they will impact providers.

Note: CMS has not announced a date when the edits for Phase 2 will become active. CMS will give the provider community at least 60 days notice prior to turning on these edits.

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