On April 27, 2012 the Centers for Medicare and Medicaid Services (CMS) published a final rule that states new provider and supplier requirements. The final rule requires all providers and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all enrollment applications for Medicare or Medicaid, and on all claims submitted for payment. The rule further states that any claim submitted without the appropriate NPIs will be denied. The final rule also requires that all prescriptions under Medicare Part D include an NPI for the prescribing physician. The rule is intended to help more efficiently and accurately detect fraud, and is estimated to save taxpayers an estimated $1.59 billion over ten years.
In a press release, CMS announced that the rule “ensures that only qualified, identifiable providers and suppliers can order or certify certain medical services, equipment, and supplies for people with Medicare.”
Additionally, the rule also requires that physicians and other professionals who are permitted to order and certify covered items and services for Medicare beneficiaries be enrolled in Medicare. In an effort to further track and monitor claims, Part B items and services ordered or referred by a physician or eligible professional can only be submitted if the physician or eligible professional has an approved enrollment record, or a valid opt out record in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS).
Finally, the rule mandates document retention requirements for providers and suppliers that order and certify items and services for Medicare beneficiaries. Under the final rule providers and suppliers must maintain ordering and referring documentation, including the NPI, received from a physician or eligible non physician practitioner for seven years from the date of service. Further, failure to comply with the documentation retention requirements is reason for revocation.