Wednesday, April 25, 2012 Рsource:

CMS has released a final rule requiring health care providers and suppliers to use a National Provider Identifier number when they submit Medicaid or Medicare claims, as well as when they apply to enroll in the programs, Health Data Management reports (Goedert, Health Data Management, 4/24).

The final rule will take effect 60 days after its publication in the Federal Register on April 27.

About the NPI

The NPI is a 10-digit identification number that will be required for use in all HIPAA-eligible transactions.

The number aims to help curb fraud and abuse in Medicare and Medicaid by making it easier to verify the identities of health care providers and suppliers (McKinney, Modern Physician, 4/24).

Details of the Final Rule

CMS said the final rule will ensure that only qualified, identifiable health care providers and suppliers are ordering or certifying medical services, equipment and supplies for Medicare and Medicaid beneficiaries.

In addition, the rule will help ensure that beneficiaries receive quality care because CMS will verify the credentials of physicians ordering or certifying supplies, the agency said (Monegain, Healthcare IT News, 4/24).

CMS said there are several differences between the interim and final rule, including:

  • The agency will deny — not just reject — claims that do not include an NPI;
  • Medical residents practicing in states where they are allowed to be licensed will be able to use an NPI to enroll in Medicare; and
  • In states where medical¬†residents are not allowed to be licensed, the teaching physician will need to provide an NPI (Modern Physician, 4/24).