The Centers for Medicare & Medicaid Services recently announced a final rule that prevents fraud in Medicare and is estimated to save taxpayers nearly $1.6 billion over 10 years. The final rule finalizes several provisions of the Affordable Care Act implemented in the May 5, 2010 interim final rule with comment period.
According to the CMS press release, the rule ensures that only qualified, identifiable providers and suppliers can order or certify certain medical services, equipment and supplies for people with Medicare. The rule also helps ensure beneficiaries receive quality care because CMS will verify the credentials of a provider who is ordering or certifying equipment and supplies. The rule mandates document retention and provision requirements on providers and supplier that order and certify items and services for Medicare beneficiaries.
“Thanks to the Affordable Care Act, we are expanding our work to combat fraud,” stated Deputy Administrator for Program Integrity Peter Budetti. “This rule will save money for taxpayers and ensure people with Medicare get high-quality care.”
In addition, the final rule continues to require that all providers and suppliers who qualify for a unique identification number – the National Provider (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 physician or eligible professional and to check for suspicious ordering activity.
This rule builds on the work CMS is also doing in Medicare Part D by requiring that all prescriptions include an NPI for prescribing physicians. In conjunction with Part D, these efforts will help better safeguard the Medicare Trust Funds by giving CMS the ability to know which providers are ordering, certifying and prescribing items and services to Medicare beneficiaries.