Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements

On May 5, 2010, CMS issued an interim final rule implementing provisions of the Patient Protection and Affordable Care Act (PPACA).  The rule implements the provision which requires 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 programs.

The rule also requires physicians and eligible professionals to order and refer covered items and services for Medicare beneficiaries to be enrolled in Medicare. It also adds requirements for providers, physicians, and other suppliers participating in the program to provide documentation on referrals to programs at high risk of waste and abuse, to include durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), home health services, and other items or services.