New NPI Rule

CMS is issuing new rules and changes to enrollment requirement, as well as requirements for ordering and billing products and services. A new program integrity final rule was released on April 24, and published in the Federal Register on April 27. It takes effect in late June.

According to the new rule, only qualified, identifiable providers and suppliers can order or certify for services such as DMEPOS, laboratory and imaging services, and home health. The rule requires that a valid National Provider Identifier (NPI) number will be required on all claims as well as enrollment applications.

Ophthalmologists and optometrists are familiar with the requirement to have the ordering/referring physician’s name and NPI on claims for diagnostic tests, so that isn’t a change. What is different is a new requirement that you must keep documentation of all orders for seven years from the original date of service. If you prescribe postcataract eyeglasses, you will also be affected.

The rule may be read at

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