Home Health & Hospice Week

If you haven't applied yet, you could be on CMS' bad list.

Providers have an extra 12 months to get into compliance with National Provider Identifier rules--but only if they have a good reason.

The Centers for Medicare & Medicaid Se-vices indicates in a recent NPI Frequently Asked Ques-tion that it won't go easy on providers who slack on NPI requirements.

In response to a question about what CMS wants to see in an NPI contingency plan, the agency says it will "assess whether covered entities have exhibited diligence and good faith efforts towards compliance."

An important part of doing that is applying for a number. "Providers that have not yet obtained NPIs, should do so immediately," CMS instructs. "Failure to obtain an NPI may be viewed as a violation of the good faith provisions of CMS' contingency guidance."

A break: CMS will investigate NPI violations only when it receives a complaint, the agency adds.

Experts recommend you take these steps now to steer clear of NPI trouble: 1. Apply for your own number. As CMS stresses, you should have applied for your own NPI already. "If [providers] haven't, they should make extraordinary efforts to do so," advises attorney Deborah Randall with Arent Fox in Washington, DC.

"Apply right now!" urges Burtonsville, MD-based attorney Elizabeth Hogue.

Document: And don't forget to record your application efforts, advises consultant Pam Warmack with Clinic Connections in Ruston, LA. "Document with dates and times each action taken towards securing a number," Warmack says. If you fail to secure a number for a particular reason, you should document the names of individuals you have contacted in an attempt to rectify the problem. 2. Draft your contingency plan. If you're not completely in compliance with NPI rules, which means using referring physicians' NPIs instead of UPINs on all claims by May 23, you must have a contingency plan stating how and when you will come into compliance.

CMS' guidance on what makes an acceptable contingency plan is maddeningly vague. "CMS guidance rarely leaves room for anything but confusion," Warmack laments.

In response to the contingency plan question, CMS says it "will not routinely make judgments nor approve contingency plans."

"It is virtually impossible to determine what CMS will regard as due diligence and good faith effort," Hogue judges.

Helpful: But there are some clues in CMS' guidance. To comply with the "diligence and good faith" language CMS uses, plans should include evaluating the provider community with which they need to share information to determine their level of readiness and willingness to share NPIs, counsels attorney Marie Berliner with Lambeth & Berliner in Austin, TX. And contacting other providers directly should be in the plan.

"The plan must be substantive and supported by actual documentation of the efforts made," Berliner [...]