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BIPA Proposed Rule

3/8/2017
Debbie Ayres
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Be Prepared: How the BIPA Regulation May Impact You

CMS recently released the much anticipated proposed rule to implement BIPA 2000, Section 427. There has been quite a bit of concern about the potential changes for orthotic and prosthetic practitioners who provide custom care for Medicare patients. 

A part of the profession's response to the proposed rule focuses on the potential use of a National Provider Identifier (NPI) number by all practitioners providing custom orthotic, prosthetic and pedorthic care. The current practice of reimbursing facilities for orthotic, prosthetic or pedorthic care will not change. However, it is possible that in the future Medicare will require that individual practitioners who deliver beneficiary care have an NPI number.

ABC sees this is a positive move for the profession. If implemented, the NPI requirement for O&P claims is a way for Medicare to limit the types of items non-O&P professionals can provide. Our comments on the proposed rule will suggest that this requirement be included, as we see this as a way to identify what type of Qualified Practitioner furnishes custom O&P care.

Obtaining an NPI number is NOT a requirement at present and if you do not have an NPI number you are still able to submit a claim for custom services to Medicare. However, if Medicare implements our suggestion it is possible that in the future an NPI number will be required to submit a claim for custom services to Medicare. Therefore, we encourage you to obtain an NPI number IN CASE Medicare begins to require NPI numbers for individual practitioners.

ABC does not want you to be left out if this change is made in the future. There is no cost to ​​​​apply for an NPI number and we encourage every orthotist, prosthetist and pedorthist to obtain their own individual NPI now. Not sure if you already have an NPI number? Check here.​​

There is no reason to wait!


FAQ’s

​​​What is an NPI number?
​A National Provider Identifier o​​r NPI is a unique 10-digit identification number issued to health care providers in the U.S. by the Centers for Medicare and Medicaid Services (CMS)
Are NPI numbers currently required to submit a claim for custom orthotic, prosthetic or pedorthic  services to Medicare?
​No.
Why should O&P professionals apply for an NPI number?
​It is possible that in the future Medicare will require that individual practitioners who deliver O&P care to Medicare beneficiaries have an NPI number. If this becomes required, an NPI number would identify what type of Qualified Practitioner provides custom O&P care as well as be a way for Medicare to limit the types of items non-O&P professionals can provide.
What if Medicare does not implement a requirement for an NPI number? 
​There is no harm in having an NPI number, even if it is not used in claim submission. 
What does it cost to apply for an NPI number?
​There is no cost to apply for an NPI number. 
How do I check to see if I already have an NPI number? 
Click Here to see if you already have an​ NPI number.
How do I apply for an NPI number?
​Applying for an NPI number is quick and easy. Click Here​ t​o apply.
The NPI application asks for Taxonomy Codes.  What code should I use?
  • Orthotist - 222Z00000X​
  • Prosthetist - 24P00000X​
  • ​Pedorthist - 224L00000X​​
Will I have to renew my NPI number at some point?
​No. Once it is created you never have ​to renew your NPI number.​