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Medicare

Marilyn Posted Fri 16th of May, 2014 17:11:49 PM

Medicare Claims are denied for not having an "ordering/referring" provider in box 17/b of cms1500. Patient's are "self referred" and Registered Dietician/Nutritionist as rendering provider. In this case, do I label the rendering provider also as the "ordering" provider to enter in box 17/b on claim form?

SuperCoder Answered Thu 22nd of May, 2014 18:23:39 PM

If the patient self referred to the practice and it was just an office visit no info was needed in that box. If the provider then did labs or a procedure as a result of the patient self referring use MD as the ordering/referring in box 17.

The referring/ordering provider is needed for certain services. I would be interested to know what type of service you are billing. If you are billing just an office visit then the referring/ordering provider is not needed in box 17. If you are billing a x-ray or labs you can use the MD that is supervising the registered dietitian. It does not appear that a registered dietitian is a provider that is an approved ordering or referring provider.

Marilyn Posted Mon 02nd of June, 2014 18:08:52 PM

Visits are just regular office visits with Registered Dieticians/Nutritonists., no labs or procedures. Claims were filed at first with having box 17 blank but denied for not having a ref/ordering. I called Medicare, and I was told that box 17 cannot be blank so I resubmitted claims with the rendering as referring which of course denied for type or provider cannot be an ordering or referring. Don't know what else to do. Is there a Medicare policy on billing for Nutrition? Help.

Marilyn Posted Mon 02nd of June, 2014 19:07:46 PM

The claims that denied for box 17 being blank were filed via paper claims. Resubmitted via electronic filing with box 17 having the rendering as the ordering and denied for type of provider cannot be an ordering nor a referring provider.

Marilyn Posted Tue 03rd of June, 2014 10:18:42 AM

We bill Medicare CPT codes 97802/97803 for Nutrition services. Per Medicare With this codes, box 17 needs a reffering physician. Are this codes correct to bill Medicare?

SuperCoder Answered Tue 03rd of June, 2014 11:48:41 AM

We have researched this question again and have come to the same conclusion. A registered dietitian/nutritionist is not eligible to order or refer services. The following excerpt is from a CMS outreach and education. There are certain requirements for ordering and referring providers:

1. The ordering/referring provider’s NPI must be for an individual physician or NPP
2. The physician or NPP must be enrolled in Medicare
3. The physician or NPP must be of a specialty type that is eligible to order and refer.

Further down in the publication, CMS explains the types of specialties that are eligible to order and refer. A registered dietitian/nutritionist is not one of the listed eligible specialties.

• Certified nurse midwives
• clinical nurse specialists
• clinical psychologists
• clinical social workers
• interns, residents, and fellows
• nurse practitioners
• optometrists
• physician assistants
• physicians.

The edits should only be checking for claims where clinical lab tests, imaging, DMEPOS, and Part A HHAs. So I’m still not understanding why your claims are getting denials for regular office visits.

I would suggest that if you have a MD that supervises the RD that they work together. Incident-to-billing would be an option and would eliminate the issue with the referring/ordering edits.

Here is the link for the article

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedEnroll_OrderReferProv_FactSheet_ICN906223.pdf

Hope this helps!

Marilyn Posted Thu 05th of June, 2014 18:24:29 PM

Thank you. I did find the same answer as well.

SuperCoder Answered Fri 06th of June, 2014 07:46:36 AM

You are welcome!

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