Changes to ordering, referring process implemented

Starting May 1, the Centers for Medicare & Medicaid Services (CMS) will implement edits to prevent payment for services ordered or referred by providers not enrolled in the Medicare program.

The policy was first announced in 2009 and was delayed amid the numerous concerns raised by the American College of Cardiology (ACC), the American Medical Association and others.

Enrollment does not require that providers participate in the Medicare program, merely that their information is contained within CMS’ provider database. The ACC recommends that cardiologists check their Medicare provider enrollment information to ensure it is current and accurate.

For details on the changes, additional ACC recommendations, and a sample letter for referral sources, visit