CMS Releases Final Rule on Provider Enrollment

On April 24, the Centers for Medicare and Medicaid Services (CMS) released a final rule on provider enrollment aimed at preventing Medicare fraud. The rule will save an estimated $1.6 billion over the next decade. However, specialists are exempt from the rule since Medicare beneficiaries are not required to have a referral in order to see a specialist.

Of note, providers and suppliers will be required to provide their National Provider Identifier (NPI) on all Medicare or Medicaid enrollment applications as well as on any reimbursement claims. "To maintain program integrity and ensure quality, we must make certain that only qualified providers and suppliers participate in the programs and that they bill accurately for their services," said CMS. Moving forward, all claims that fail to include an NPI will be rejected. This follows on the heels of the Medicare Part D requirement that all prescriptions include an NPI for prescribing physicians. 
The rule also addressed how teaching hospitals will be affected. Straying from the interim rule that has been in place since 2010, this final rule states that residents can enroll in Medicare in states where they are licensed to practice and order treatments; however, teaching physicians will be required to include an NPI in states where residents are not licensed.

The ACC is currently reviewing the new rule and will provide more detailed information on its impacts to cardiology in the coming days.

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