News from the AOA's Blog

The names and National Provider Identifier (NPI) numbers of 800,000 health care practitioners, eligible to order or refer items and services under Medicare, is now available online, according to the U.S. Centers for Medicare & Medicaid Services (CMS). Optometrists are eligible to order and refer items and services in Medicare. However, as of April 5, 2010, the CMS plans to require eligible physicians to have a “current” enrollment record, which means an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS) database that Medicare began using in 2003.

Optometrists should immediately check to make sure they are listed in the new online Medicare Ordering/ Reporting Report – and, if not, strongly consider re-enrolling as Medicare providers, the AOA Advocacy Group advises.

Practitioners should also begin checking the eligible practitioner list before filling eyewear prescriptions written outside their offices for Medicare beneficiaries, the AOA Advocacy Group advises.

Posted online in January, the new Medicare Ordering/ Referring Report lists physician and non-physician practitioners who have current enrollment records – complete with an NPI – in the PECOS database. The PECOS database includes physicians who have enrolled or re-enrolled in Medicare since 2003. In order to be listed in the database, doctors who enrolled prior to 2003 must re-enroll by submitting a complete enrollment application to their Medicare carrier or contractor.

As part of a crackdown on payment abuses, the CMS has ordered Medicare payment contractors, effective April 5, to honor claims for items (including cataract eyeglasses) or services only when ordered or referred by a physician whose enrollment records are included in PECOS. The new restriction also applies when patients are referred for services (such as lab tests or therapy).

The Medicare Ordering/Referring Report can be accessed at www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/OrderingReferringReport.pdf. Health care practitioners may need to enter an individual (type 1) NPI to verify whether they are on the list. Practitioners can find their NPIs using the Medicare NPI Registry (https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.doc).