Home Health & Hospice Week

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 a 1999 figure of $91 million -- but not far enough, the OIG contends.

Breakdown: The vast majority -- $27.8 million -- of claims with incorrect UPINs were inactive, meaning the practice setting they represented was inactive. The Centers for Medicare & 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.

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 high-profile news articles in the New York Times and USA Today (see Eli's HCW,Vol. XVII, No. 26, p. 206).

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. Areturn 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.