CMS Issues Rule on NPI, Documentation Maintenance

BALTIMORE — According to an interim final rule issued by
CMS and published in today’s Federal Register, all
providers and suppliers who qualify for a National Provider
Identifier, including those in the DME sector, must include the NPI
on enrollment applications and reimbursement claims for federal
health care programs.

The IFR implements anti-fraud provisions in the health reform
law, which has come to be known as PPACA (the Patient Protection
and Affordable Care Act). Those affected must be in compliance with
the rule by Jan. 1, 2011.

Under Section 6406 of PPACA, the rule also adds requirements for
physicians, providers and suppliers participating in Medicare to
provide documentation on referrals to DMEPOS, home health or other
programs deemed “at high risk of waste and abuse” by the HHS
Secretary. Documentation can include written or electronic records,
including the NPI of the physician who ordered or referred the
services, and must be kept for seven years.

If providers fail to meet the documentation requirements, CMS
can revoke enrollment in federal health care programs for up to a
year.

The IFR takes effect July 6, with comments due by July 2.

View the full text of the rule, which also includes
instructions for commenting.