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CMS final rule requires provider identification verification

April 25, 2012
by Patricia Sheehan
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The Centers for Medicare & Medicaid on Tuesday announced a final rule that aims to ensure that only qualified, identifiable providers and suppliers can order or certify certain medical services, equipment and supplies for people with Medicare.

The final rule, effective June 26, also continues to require that all providers and suppliers who qualify for a unique identification number—the National Provider Identifier (NPI)—include their NPI on applications to enroll in Medicare and Medicaid and on all reimbursement claims submitted. This gives CMS and states the ability to tie specific claims to the ordering or certifying provider or eligible professional and to check for suspicious ordering activity.

CMS projects the final rule will help prevent Medicare fraud and save nearly $1.6 billion over 10 years.