Eligible Physicians and Non-Physician Practitioners who need to Enroll in the Medicare Program for the Sole Purpose of Ordering and Referring Items and Services for Medicare Beneficiaries

CR 7097 announces that physicians and non- physician practitioners will need to enroll in the Medicare program so they can order and refer items and services for Medicare beneficiaries.

The enrollment requirement is applicable to those physician and non-physician practitioners of a profession eligible to order and refer who are:
∑         Employed by the Department of Veterans Affairs (DVA), Public Health Service (PHS), Department of Defense (DOD) TRICARE, or by Medicare enrolled Federally Qualified Health Centers (FQHC), Rural Health Clinics, (RHC), or Critical Access Hospitals (CAH);
∑         Physicians in a fellowship; or
∑         Dentists, including oral surgeons.
∑         Other employed eligible physicians and non-physician practitioners
Modified Enrollment Process for Physicians and Non-Physician Practitioners who are Enrolling Solely to Order and Refer
To enroll in Medicare for the sole purpose of ordering or referring items or services, you must do the following:
1. Complete the following sections paper of form CMS-855I (“Medicare Enrollment Application for Physicians and Non-Physician Practitioners”):
            Section 1 ñ Basic Information (you would be a new enrollee);
            Section 2 ñ Identifying Information (section 2A, 2B, 2D and if appropriate 2H and 2K);
            Section 3 ñ Final Adverse Actions/Convictions;
            Section 13 ñ Contact Person; and
            Section 15 – Certification Statement (must be signed and datedblue ink recommended).
2. You must include a cover letter with this enrollment application stating that you are enrolling for the sole purpose of ordering and referring items or services for a Medicare beneficiary and cannot be reimbursed by the Medicare program for services that you may provide to Medicare beneficiaries.
Your designated Medicare enrollment contractor will verify that the information you provided on the application meets the Medicare requirements for your profession and, if approved, will enter the data into PECOS. This will place you on the Ordering Referring File that is available on the Medicare provider/supplier enrollment web site (https://www.cms.gov/MedicareProviderSupEnroll) and the information will be in the Medicare claims system so that claims for the items or services you ordered or referred can be paid.