May 1 signals changes to ordering/referring process

After a lengthy delay, the Centers for Medicare & Medicaid Services (CMS) announced that, beginning on May 1, it 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 be participating 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