The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

Additional InformationYou may want to review the following related CRs:• CR 6417 at http://www.cms.gov/Transmittals/downloads/R642OTN.pdf on the CMS Web site;• CR 6421 at http://www.cms.gov/Transmittals/downloads/R643OTN.pdf on the CMS Web site; and• CR 6696 at http://www.cms.gov/Transmittals/downloads/R328PI.pdf on the CMS Web site.If you have questions, please contact your Medicare carrier, Part A/B Medicare administrative contractor(A/B MAC), or durable medical equipment Medicare administrative contractor (DME/MAC), at their tollfreenumbers, which may be found athttp://www.cms.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.DisclaimerThis article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links tostatutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of eitherthe written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statementof their contents.Physicians and Nonphysician Practitioners Excluded from Deactivationin Medicare Due to Inactivity with MedicareMLN Matters® Number: SE1034Related Change Request (CR) #: N/ARelated CR Release Date: N/AEffective Date: N/ARelated CR Transmittal #: N/AImplementation Date: N/AProvider Types AffectedPhysicians and nonphysician practitioners (NPPs) who need to enroll in the Medicare Program for thesole purpose of ordering and referring items and services for Medicare beneficiaries are excluded fromthe process that would deactivate them after 12 consecutive months of nonbilling.Provider Action NeededThis article is for certain physicians and NPPs who have the unique enrollment scenarios of enrolling forthe sole purpose of ordering and referring items and services for Medicare beneficiaries. These physiciansand NPPs do not and will not send claims to a Medicare contractor for the services they furnish and shallbe excluded from the 12-month nonbilling deactivation process. The supplier types affected are listed inthe Background section of this article.BackgroundThe Centers for Medicare & Medicaid Services (CMS) instructs Medicare contractors to deactivate therecords of physicians and NPPs who have had no activity in submitting claims to Medicare contractorsfor 12 consecutive months. However, CMS excludes certain physicians and NPPs from this deactivationprocess and has instructed Medicare contractors accordingly. The supplier types that are excluded fromdeactivation for nonbilling include the following physicians and NPPs who are employees of Departmentof Veterans Affairs (DVA), Department of Defense (DOD), or public health service (PHS) and employeesof Medicare enrolled federally qualified health center (FQHC), critical access hospital (CAH), and ruralhealth clinic (RHCs):• Doctor of medicine or osteopathy;• Doctor of dental medicine;• Doctor of dental surgery;CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 94 MMR 2011-01, January 2011