CMS announced a final rule today to prevent fraud in Medicare, which is estimated to save taxpayers nearly $1.6 billion over 10 years. This rule ensures that only qualified, identifiable providers and suppliers can order or certify certain medical services, equipment and supplies for people with Medicare.  The rule also helps ensure beneficiaries receive quality care because CMS will verify the credentials of a provider who is ordering or certifying equipment and supplies.

In addition, the final rule continues to require that all providers and suppliers who qualify for a unique identification number – the National Provider (NPI) – include their NPI on applications to enroll in Medicare and medicaid and on all reimbursement claims submitted.  This gives CMS and States the ability to tie specific claims to the ordering or certifying physician or eligible professional and to check for suspicious ordering activity.

This rule builds on the work CMS is also doing in Medicare Part D by requiring that all prescriptions include an NPI for prescribing physicians.  In conjunction with Part D, these efforts will help better safeguard the Medicare Trust Funds by giving CMS the ability to know which providers are ordering, certifying and prescribing items and services to Medicare beneficiaries.

To see the final rule, get the PDF document at this link.