Home Health & Hospice Week

But you have until May 2008 to include referring docs' new numbers.

Providers wondering how to comply with the latest NPI rules finally have some concrete information.

The Centers for Medicare & Medicaid Services announced earlier this month that because providers and other covered entities aren't ready to use National Provider Identifier numbers on their Medicare claims, it was extending the NPI deadline for a year (see Eli's HCW, Vol. XVI, No. 12).

Limit: But now CMS says the primary provider requesting payment with the claim may have to have its NPI as early as July. "As soon as the number of claims submitted with an NPI for primary providers ... is determined sufficient ... Medicare will begin rejecting claims that do not contain an NPI for primary providers," CMS says in MLN Matters article MM5595 finalized April 24.

Primary providers for NPI purposes are "billing, pay-to and rendering providers," CMS explains.

What's next: In May, CMS will assess how many providers are submitting claims with their NPIs. If the ratio is high enough, it will start requiring NPIs from the primary providers in July, the article says. If the ratio isn't yet high enough, it will reassess in June for an August implementation.

Off the hook: However, home care providers don't have to furnish referring physicians' NPIs on claims until May 2008. Providers can include "secondary" providers' legacy numbers, including UPINs, on Medicare claims until that date. "If a secondary provider's NPI is present, it will only be edited to assure it is a valid NPI," CMS assures.

Until the to-be-announced NPI deadline, providers can include NPIs, legacy numbers or a combination of NPIs and old numbers on their claims, CMS says in April 24 Change Request 5595.

Providers not in full compliance with the NPI requirement must have a contingency plan by May 23 when the NPI deadline hits, CMS says (see Eli's HCW, Vol. XVI, No. 14).

The MLN Matters article is at www.cms.hhs.gov/MLNMattersArticles/downloads/MM555.pdf. The CR is at www.cms.hhs.gov/Transmittals/downloads/R1227CP.pdf. • CMS has released the list of HCPCS codes included in the first round of competitive bidding for durable medical equipment. Bidding is expected to begin very soon.

The information is posted on the Competitive Bidding Implementation Contractor Web site. For a list of all codes included in each category, go to www.dmecompetitivebid.com. • You shouldn't follow the National Pressure Ulcer Advisory Panel's new pressure ulcer guidelines just yet. "We are aware of the new guidance," CMS' Pat Sevast said at the National Association for Home Care & Hospice's Washington, DC policy conference April 23. Even though OASIS instructions refer to NPUAP guidelines, the agency is looking at the guidance to see how adopting it would affect reimbursement before deciding what [...]