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Medicare Update => Winter 2006/2007

Alfred H. moffett, Jr., MD
Medicare Representative

Four Points of Interest

For this edition of Ob/Gyn Today, I'd like to direct your attention to the following four items. Number 3, regarding 2007 reimbursement rates, is especially good news.

  1. National Provider Identifier (NPI): HIPPA requires all providers to have an NPI number by May 23, 2007. Each physician must have a separate NPI, which cannot be done by "group." Claims will be denied without it! You can apply online at nppes.cms.hhs.gov to obtain an NPI number if haven't done so already. Make sure you have available all of your personal numbers when you sign on (license, UPIN, Medicaid, Medicare, Tax ID). Also, be sure to inform your hospital's credentialing department once you have your NPI number.

    Where to go to get more information:
         nppes.cms.hhs.gov
    Web based applications: 800-465-3203
    or TTY 800-692-2326
    www.cms.hhs.gov/medlearn/npi/npiviewlet.asp
    • Explains NPI
    • Provider description of the system
    • Leads you through the applications


  2. The National Uniform Claim Committee (NUCC) and the Office of Management and Budget (OMB) have approved a revised CMS-1500 (08/05) paper form that accommodates both the National Provider Identifier (NPI) number and legacy identifiers. The NUCC recommendations are that payers should begin to accept either the current or revised CMS-1500 form between October 1, 2006 and March 31, 2007, and effective April 1, 2007, payers should accept only the revised CMS-1500 form. Keep in mind that these dates are a recommendation, not a requirement. CMS (Medicare) began accepting the revised CMS-1500 paper form on January 2, 2007 and requires it as of April 2, 2007.


  3. 2007 Medicare Rates: The 5% physician payment cut was stopped, freezing 2007 physician payments at 2006 rates. If you need to obtain information regarding fees or the 2007 HCPCS, log onto to obtain information.


  4. No new policies of great concern to obstetricians/gynecologists are being reviewed at this time.