Department of Health and Human Services, Centers for Medicare & Medicaid Services: Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements
GAO-12-714R: May 11, 2012
- Full Report:
GAO reviewed the Department of Health and Human Services, Centers for Medicare & Medicaid Services' (CMS) new rule on changes in Medicare and Medicaid Programs' provider and supplier enrollment, ordering and referring, and documentation requirements; and changes in provider agreements. GAO found that (1) the final rule requires all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs. In addition, it requires physicians and other professionals who are permitted to order and certify covered items and services for Medicare beneficiaries to be enrolled in Medicare. Finally, it mandates document retention and provision requirements on providers and suppliers that order and certify items and services for Medicare beneficiaries; and (2) CMS complied with the applicable requirements in promulgating the rule.