The Centers for Medicare & Medicaid Services (CMS) has issued a final rule that will require providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under these programs. The new rule by CMS also requires physicians and other professionals who are permitted to order and certify covered items and services for Medicare beneficiaries to be enrolled in Medicare. It also mandates document retention and provision requirements on providers and suppliers that order and certify items and services for Medicare beneficiaries.
According to CMS, the rule will save Medicare roughly $1.6 billion over a decade. CMS said it based its Medicare savings estimate on a decrease in the use of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), imaging services, clinical laboratory services, and home healthcare because a small number of patients will go to physicians without enrollment numbers and thus will not get referrals to these services. Also, some provider claims without proper documentation, including some fraudulent claims, could be denied as a result of the rule, but CMS said it does not have a basis for quantifying the value of such claims.
CMS currently requires providers of medical or other items or services and suppliers that qualify for an NPI to include their NPI on all enrollment applications and claims for payments submitted under the Medicare and Medicaid programs, according to an interim final rule that was published in May 2010.
The final rule, Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements, is scheduled for publication in the Federal Register on April 27, 2012, and will take effect June 26, 2012.
