The reporting rules for claims filed with NIU's and how these claims are reviewed by Medicare are found in OEI-04-1V-01010. This report provides the following information: · Information on the number of records of claims submitted for items and services furnished between 2010 and 2012. · Information on the number of records from those claims with matching reference identifiers for physicians and suppliers, NIU's and Medicare Advantage Plans that were reviewed by the Office of the Medical Inspector General and the Inspector General of the Centers for Medicaid & Medicare Services, respectively. · Information on the number of records with matching NIU's for physicians and suppliers and Medicare Advantage Plans reviewed for payment by Medicare. · Information on the number of records with matching Medicare payment for medical equipment and supplies for which both reference identifiers were used. · Information on the number of records with matching Medicare payment for medical equipment and supplies for which only one reference identifier was used. · Identification of individual physician and supplier National Provider Identifiers (NPS) used on the records. · Explanation of the manner in which the NPS were identified. · Information on the number of NIU's and NPS used from October 2008 through August 2010. · Information on the number of NIU's and NPS used from September 2010 through May 2011. · The number of Medicare Advantage Plans with a similar use of National Provider Identifiers (NPS) through September 2010. · Information on how Medicare paid each claim in order to identify the doctor or supplier with a National Provider Identifier matching reference identifiers. · The number of other patients referred to by the patient referred to in the record of claims. · Information on the number of other patients referred to for the medical equipment and supplies for which a NIU and NPI were used. · Information on the number of other patients referred through the Medicare Advantage Plans in which a NIU and NPI were used. · Information on the number of patients referred for the medical equipment and supplies for which a single reference identifier was used for multiple doctors and suppliers. · Information on the number of records identified through different sources for the same item or services for different physicians or suppliers. · The average value paid on each such claim, including: gross charges, reimbursement, net costs, and other items. · The number of patients who were referred for the medical equipment and supplies on which a single reference identifier was used without any other identifying information.
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DEPARTMENT OF HEALTH & HUMAN SERVICES Office of Inspector General Washington, D.C. 20201 APR 08 2010 TO: Charlene Frizz era Acting Administrator Centers for Medicare & Medicaid Services FROM: Stuart
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