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Medicare Advantage Organizations' Collection of Ordering Provider Identifiers

The availability of ordering provider identifiers in the Medicare Advantage (MA) encounter data is essential for using these data to identify and prevent potential fraud, waste, and abuse. However, CMS does not require MA organizations (MAOs) to submit National Provider Identifiers (NPIs) for ordering providers. In past work, OIG found that nearly two-thirds of records for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), clinical laboratory, imaging, and home health services reviewed did not include the NPI for the ordering provider. OIG recommended that CMS require MAOs to submit ordering provider identifiers. This study will determine the extent to which MAOs obtain the NPIs of providers who order DMEPOS, clinical laboratory services, imaging services, and home health services for MA enrollees and will determine how MAOs that do not obtain these identifiers are conducting routine monitoring, auditing, and oversight of these types of services. In addition, this study will provide updated information on how many MAOs voluntarily submit NPIs of providers who order DMEPOS, clinical laboratory services, imaging services, and home health services to CMS.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
May 2020 Centers for Medicare & Medicaid Services Medicare Advantage Organizations' Collection of Ordering Provider Identifiers Office of Evaluation and Inspections OEI-03-19-00430 2020