Home Health & Hospice Week

Making sure your referring physicians are in the PECOS database may become easier, now that Medicare has updated its National Plan and Provider Enumeration System (NPPES).

Don’t forget: The so-called PECOS edit denies home health agency claims when the physician’s data isn’t found in the PECOS file, as drawn from the NPPES. Medicare began denying claims based on this edit in 2014 (see Eli’s HCW, Vol. XXII, No. 44-45).

The Centers for Medicare & Medicaid Services is simplifying the NPPES process and adding enhancements that make accessing the system more efficient and convenient, it says. In an effort to address longstanding issues with shared login information, particularly in practices that support type 2 providers, CMS streamlined the way both clinicians and suppliers “obtain and manage” their National Provider Identification (NPI) accounts, a recent MLN Matters release on the topic suggests.

“The Centers for Medicare & Medicaid Services has modernized the NPPES (NPPES 3.0) that now has unified login for type 1 and type 2 providers,” MLN Matters SE17016 says. The brief adds that the change “increases security, provides new surrogacy functionality, has a more responsive User Interface (UI) and a streamlined NPI application process.”

Reminder: Physicians can have an individual, Type 1 NPI or a practice association (PA) or limited liability corporation (LLC) Type 2 NPI, notes the Texas Medical Association on its website.

These new NPPES updates aren’t “limited or restricted to Medicare,” the MLN Matters article notes, but rather “include all physicians, providers, and suppliers.”

Resource: For a closer look at MLN Matters SE17016, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE17016.pdf.