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CMS Releases Final Rule Requiring Providers to Include NPI on Enrollment and Claim Filings

Posted on April 26, 2012 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

The Centers for Medicare & Medicaid Services (CMS) just released a final rule requiring all 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 the Medicare and Medicaid programs.  The final rule will be published in the April 27th Federal Register, and the rule will become effective 60 days after publication, June 26.

This rule is designed to maintain program integrity and ensure quality by allowing CMS to verify that only qualified providers and suppliers participate in the programs and that they bill accurately for their services.  CMS estimates the implantation of this rule will save Medicare $1.6 billion over 10 years. The NPI, which also is required in HIPAA transactions, is used to verify certification as a means of curbing Medicare and Medicaid fraud and abuse.

The final rule with comments will be published this Friday in the Federal Register.

Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.