Medicare Compliance & Reimbursement

In 2007, durable medical equipment suppliers received $34 million in Medicare payments based on inactive or invalid physician UPINs and National Provider Identifier numbers, the HHS Office of Inspector General finds in a new report (OEI-04-08-00470). That's down from $91 million in 1999 -- but not far enough, the OIG contends.

Breakdown: $27.8 million worth of claims with incorrect UPINs were inactive, meaning the practice setting they represented was inactive. The Centers forMedicare & Medicaid Services paid $6 million for claims with invalid UPINs, meaning the UPIN had never been assigned. Only $300,000 in claims had invalid NPIs, since the NPI requirement just took effect in May of that year.

Of the claims with inactive UPINs, $5 million were due to deceased physicians, the OIG reports. That's down from $8 million in 1999.

More than 7 percent of the physicians whose numbers were on claims had been deceased for more than five years before the claim's date, the OIG criticizes in the report.

Caveat: Some of the DME claims for deceased physicians were probably OK because the doc may have died during a prescription period of up to 13 months. But only 17 percent of claims fit into this category, the OIG says.

Suppliers took major heat last summer for billing related to deceased physicians, culminating in a Senate hearing and highprofile news articles in the New York Times and USA Today.

The OIG wants CMS to take the following steps, it says in the report:

• Determine why claims with identifiers for deceased referring physicians continue to be paid;

• Implement claims system changes to ensure NPIs for both referring physicians and suppliers are valid and active;

• Emphasize to suppliers the importance of using accurate NPIs for themselves and their referring physicians; and

• Determine the earliest date to end the provision that allows suppliers to submit claims without referring physician NPIs.

Watch out: The last recommendation could put DME suppliers in a world of billing hurt, experts predict. CMS instituted the policy of allowing providers to use their own NPIs in place of the referring physician's because providers were having such a hard time securing NPIs from docs. A return to the original requirement will also likely mean a return to the NPI-acquisition and billing difficulties.

In comments on the report, CMS says it concurs with the recommendations and has already taken some steps to alleviate DME billing problems.

Note: The report is at www.oig.hhs.gov/oei/reports/oei-04-08-00470.pdf.