Question: How should a health plan determine what receipts to use to decide whether it qualifies as a 'small health plan'?
Answer : A small health plan is defined at 45 C.F.R.§ 160.103 as “a health plan with annual receipts of $5 million or less.” Health plans that report receipts to the IRS on identified tax forms. Health plans that file certain federal tax returns and report receipts on those returns should use the following guidance provided by the Small Business Administration at 13 C.F.R. § 121.104 to calculate annual receipts: Receipts means 'total income' (or in the case of a sole proprietorship, 'gross income') plus 'cost of goods sold' as these terms are defined or reported on Internal Revenue Service (IRS) Federal tax return forms; Form 1120 for corporations; Form 1120S for Subchapter S corporations; Form 1065 for partnerships; and Form 1040, Schedule F for farm or Schedule C for sole proprietorships). However, the term “receipts” excludes net capital gains or losses, taxes collected for and remitted to a taxing authority if included in gross or total income, proceeds from the transactions between a concern and its domestic or foreign affiliates (if also excluded from gross or total income on a consolidated return filed with the IRS), and amounts collected for another by a travel agent, real estate agent, advertising agent, conference management service provider, freight forwarder or customs broker.In calculating receipts under this guidance, health plans should use the definitions and process described at 13 C.F.R. § 121.104(a)(2) - (3) and § 121.104(b).•Health plans that do not report receipts to the IRS on identified tax forms.
•Health plans that do not report receipts to the IRS – for example, ERISA group health plans that are exempt from filing income tax returns – should use proxy measures to determine their annual receipts. Fully insured health plans should use the amount of total premiums which they paid for health insurance benefits during the plan’s last full fiscal year. Self-insured plans, both funded and unfunded, should use the total amount paid for health care claims by the employer, plan sponsor or benefit fund, as applicable to their circumstances, on behalf of the plan during the plan’s last full fiscal year. Those plans that provide health benefits through a mix of purchased insurance and self-insurance should combine the proxy measures to determine their total annual receipts.
Tuesday, December 8, 2009
If a health care provider with an NPI moves to a new location, must the health care provider notify the NPPES of its new address?
Question: If a health care provider with an NPI moves to a new location, must the health care provider notify the NPPES of its new address?
Answer : A covered health care provider must notify the NPPES of the address change within 30 days of the effective date of the change. We encourage health care providers who have been assigned NPIs, but who are not covered entities, to do the same. A health care provider may submit the change to NPPES via the web (https://nppes.cms.hhs.gov/) or by paper. If paper is preferred, the health care provider may download the NPI Application/Update Form (CMS-10114) from the Centers for Medicare & Medicaid Services' forms page (www.cms.hhs.gov/cmsforms) or may call the NPI Enumerator (1-800-465-3203) and request a form.
Answer : A covered health care provider must notify the NPPES of the address change within 30 days of the effective date of the change. We encourage health care providers who have been assigned NPIs, but who are not covered entities, to do the same. A health care provider may submit the change to NPPES via the web (https://nppes.cms.hhs.gov/) or by paper. If paper is preferred, the health care provider may download the NPI Application/Update Form (CMS-10114) from the Centers for Medicare & Medicaid Services' forms page (www.cms.hhs.gov/cmsforms) or may call the NPI Enumerator (1-800-465-3203) and request a form.
What does the physician referral law prohibit?
Question: What does the physician referral law prohibit?
Answer : The physician referral law (section 1877 of the Social Security Act) prohibits a physician from referring patients to an entity for a designated health service (DHS), if the physician or a member of his or her immediate family has a financial relationship with the entity, unless an exception applies. (The exceptions are specified in 42 CFR Part 411, Subpart J.) The law also prohibits an entity from presenting a claim to Medicare or to any person or other entity for DHS provided under a prohibited referral. No Medicare payment may be made for DHS rendered as a result of a prohibited referral, and an entity must timely refund any amounts collected for DHS performed under a prohibited referral. Civil money penalties and other remedies may also apply under some circumstances.
Interactive Agency
Super Bowl Tickets
Sport Events
Answer : The physician referral law (section 1877 of the Social Security Act) prohibits a physician from referring patients to an entity for a designated health service (DHS), if the physician or a member of his or her immediate family has a financial relationship with the entity, unless an exception applies. (The exceptions are specified in 42 CFR Part 411, Subpart J.) The law also prohibits an entity from presenting a claim to Medicare or to any person or other entity for DHS provided under a prohibited referral. No Medicare payment may be made for DHS rendered as a result of a prohibited referral, and an entity must timely refund any amounts collected for DHS performed under a prohibited referral. Civil money penalties and other remedies may also apply under some circumstances.
Interactive Agency
Super Bowl Tickets
Sport Events
Can a health care provider continue to use other numbers besides the NPI?
Question: Can a health care provider continue to use other numbers besides the NPI?
Answer: Only the National Provider Identifier (NPI) may be used for identification purposes for a covered health care provider in standard transactions. Legacy identifiers (such as the Unique Physician Identification Number (UPIN), Medicaid Provider Number, Medicare Provider Number, and others) may not be used. Where a covered health care provider must be identified in standard transactions for tax purposes, it is to use its Taxpayer Identifying Number as required by the implementation specifications. Health care provider identification numbers other than the NPI can be used in the internal processes and files of health plans or health care clearinghouses if they wish to continue to use those identification numbers in those internal processes and files.
Restaurant Supply
Call Center Software
Wild Blue
Answer: Only the National Provider Identifier (NPI) may be used for identification purposes for a covered health care provider in standard transactions. Legacy identifiers (such as the Unique Physician Identification Number (UPIN), Medicaid Provider Number, Medicare Provider Number, and others) may not be used. Where a covered health care provider must be identified in standard transactions for tax purposes, it is to use its Taxpayer Identifying Number as required by the implementation specifications. Health care provider identification numbers other than the NPI can be used in the internal processes and files of health plans or health care clearinghouses if they wish to continue to use those identification numbers in those internal processes and files.
Restaurant Supply
Call Center Software
Wild Blue
Is a health care provider required to obtain a National Provider Identifier (NPI)?
Question:Is a health care provider required to obtain a National Provider Identifier (NPI)?
Answer : Yes. Under the NPI Final Rule (69 FR 3434), health care providers who are covered entity under HIPAA were required to obtain an NPI and to use it to identify itself as a health care provider in HIPAA transactions as of May 23, 2007. Small health plans were required to use the NPI since May 23, 2008. A health care provider is a covered entity if it transmits any health information in electronic form in connection with a transaction for which the Secretary has adopted a standard. For example, any health care provider (individual or organization) who sends electronic health care claims to a health plan(s),is a covered provider and must obtain an NPI. Health care providers who are not covered providers may elect to apply for NPIs, but are not required to do so. For the latest information regarding NPI issues for health care providers
San Antonio Patio Furniture
Refrigerator Water Filters
Filtrete
Answer : Yes. Under the NPI Final Rule (69 FR 3434), health care providers who are covered entity under HIPAA were required to obtain an NPI and to use it to identify itself as a health care provider in HIPAA transactions as of May 23, 2007. Small health plans were required to use the NPI since May 23, 2008. A health care provider is a covered entity if it transmits any health information in electronic form in connection with a transaction for which the Secretary has adopted a standard. For example, any health care provider (individual or organization) who sends electronic health care claims to a health plan(s),is a covered provider and must obtain an NPI. Health care providers who are not covered providers may elect to apply for NPIs, but are not required to do so. For the latest information regarding NPI issues for health care providers
San Antonio Patio Furniture
Refrigerator Water Filters
Filtrete
Who is eligible to receive a National Provider Identifier (NPI)?
Question: Who is eligible to receive a National Provider Identifier (NPI)?
Angioplasty
Replacement Battery
Home Security Systems
Answer: The National Provider Identifier (NPI) was adopted as the standard unique health identifier for health care providers to carry out a requirement in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for the adoption of such a standard. An entity who meets the definition of a “health care provider” – that is, any provider of medical or other health services, and any other person or organization that furnishes, bills, or is paid for health care in the normal course of business – is eligible to receive a provider ID, or NPI. Under HIPAA, a covered health care provider is any provider who transmits health information in electronic form in connection with a transaction for which standards have been adopted. These covered health care providers must obtain an NPI and use this number in all HIPAA transactions, in accordance with the instructions in the Implementation Guides. The NPI may also be used on paper claims, but HIPAA does not govern that method of submitting claims.
In general, health care providers include hospitals, nursing homes, ambulatory care facilities, durable medical equipment suppliers, clinical laboratories, pharmacies, and many other “institutional” type providers; physicians, dentist, psychologists, pharmacists, nurses, chiropractors and many other health care practitioners and professionals; group practices, health maintenance organizations, and others. For more information and white papers about health care providers, including atypical providers, visit the CMS website at: http://www.cms.hhs.gov/NationalProvIdentStand
Angioplasty
Replacement Battery
Home Security Systems
Answer: The National Provider Identifier (NPI) was adopted as the standard unique health identifier for health care providers to carry out a requirement in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for the adoption of such a standard. An entity who meets the definition of a “health care provider” – that is, any provider of medical or other health services, and any other person or organization that furnishes, bills, or is paid for health care in the normal course of business – is eligible to receive a provider ID, or NPI. Under HIPAA, a covered health care provider is any provider who transmits health information in electronic form in connection with a transaction for which standards have been adopted. These covered health care providers must obtain an NPI and use this number in all HIPAA transactions, in accordance with the instructions in the Implementation Guides. The NPI may also be used on paper claims, but HIPAA does not govern that method of submitting claims.
In general, health care providers include hospitals, nursing homes, ambulatory care facilities, durable medical equipment suppliers, clinical laboratories, pharmacies, and many other “institutional” type providers; physicians, dentist, psychologists, pharmacists, nurses, chiropractors and many other health care practitioners and professionals; group practices, health maintenance organizations, and others. For more information and white papers about health care providers, including atypical providers, visit the CMS website at: http://www.cms.hhs.gov/NationalProvIdentStand
What is the purpose of the National Provider Identifier (NPI)? Who must use it, and when?
Question: What is the purpose of the National Provider Identifier (NPI)? Who must use it, and when?
Ultrasound Repair
X3 Hand Sanitizer Fanimation Fansc
Answer : The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims. NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways. HIPAA requires that covered entities (i.e., health plans, health care clearinghouses, and those health care providers who transmit any health information in electronic form in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard) use NPIs in standard transactions by the compliance dates. The compliance date for all covered entities except small health plans was May 23, 2007; the compliance date for small health plans was May 23, 2008. As of the compliance dates, the NPI is the only health care provider identifier that can be used for identification purposes in standard transactions by covered entities.
Ultrasound Repair
X3 Hand Sanitizer Fanimation Fansc
Answer : The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims. NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways. HIPAA requires that covered entities (i.e., health plans, health care clearinghouses, and those health care providers who transmit any health information in electronic form in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard) use NPIs in standard transactions by the compliance dates. The compliance date for all covered entities except small health plans was May 23, 2007; the compliance date for small health plans was May 23, 2008. As of the compliance dates, the NPI is the only health care provider identifier that can be used for identification purposes in standard transactions by covered entities.
Subscribe to:
Comments (Atom)