Your Medicare Supplier Number: The Key to Getting Paid

By Kathy Dodson, AOPA Government Affairs Department

AOPA has received a number of inquiries lately regarding Medicare supplier numbers and how various business situations affect the numbers. We thought it would be helpful to provide a summary of our most frequent questions and responses.

Q: I’ve gotten a National Provider Identifier (NPI). Do I still need to keep my Medicare supplier number?

A: Yes, you still need both. Although Medicare originally said that the NPI would replace your Medicare supplier number, the Centers for Medicare and Medicaid Services (CMS) has decided to keep the supplier number for use with the DME MAC’s voice inquiry system that you use to check the status of claims.

Q: I’m getting ready to apply for a new Medicare supplier number. Do I need to have my NPI first or can I get that after I get my new supplier number?

A: Apply to the National Enumerator first for a number—then use that on your Medicare supplier number application. Go to www.cms.hhs.gov/NationalProvIdentStand/03_apply.asp#TopOfPage to apply.

Q: I’m expanding my business and opening a new facility. Do I need to get a new Medicare supplier number or can I just use my old one? I intend to do all my billing out of our original location.

A: Medicare rules dictate that you must have a separate number for each location where you furnish Medicare covered services, so you do need to obtain a separate number for this new location.
This is the case even though you do not plan to bill out of that office. You may still bill out of a central location; however, on the claim form, you must use the appropriate supplier number for the location where you treated the patient.

Medicare does make a few exceptions to this rule. You do not need a separate number for locations where you do not treat patients (e.g., a storehouse or repair facility) or when you are in another facility treating the patient (e.g., a hospital, skilled nursing facility, etc).

Q: I’m buying an existing O&P company. Do I need to get a new supplier number or can I use the business’s original number?

A: It depends on the kind of purchase you made. If you made an assets-only purchase, you will need a new number. This is because you will be obtaining a new tax identification number (TIN) for that new business and will need a new supplier number to go with it. Supplier numbers are tied to TINs.

However, if you made a stock purchase of the assets and liabilities, where you will be operating the business under the original tax identification number, you do not need a new supplier number.

Q: I did a stock purchase of a company recently. Since I’m still operating under the old TIN, do I need to notify the National Supplier Clearinghouse (NSC) of anything?

A: You must notify the NSC within 30 days of the change in ownership. In this case, you would be putting in a change notice. However, if you had made an assets purchase, you would have to do a complete application for a new supplier number.

Q: I just purchased a company but I don’t yet have my new supplier number. Can I still treat Medicare patients?

A: Yes, you can still treat them, but you will have to hold your billing until you receive your new supplier number.

Be aware that you take a small risk in doing this. If for some reason you are turned down for a number, and cannot correct whatever deficiency caused the denial, you will not be receiving a new supplier number and therefore you will not be able to bill Medicare for these services. You will also not be able to bill the patients directly.

However, this prospect is not likely. As long as you provide the NSC with all the appropriate documentation, including your bill of sale, they will backdate your new supplier number to the date of the sale. At that point, once you receive your new number, you will be able to bill Medicare for the services you provided between the sale date and the time you received your new number.

Q: I’m interested in sharing office space with another O&P company. Are there any concerns regarding my supplier number?

A: Sharing space with another O&P company is not a good idea. The NSC will not approve a new supplier number for any location that already has a supplier number assigned to it.

If you want to share office space with a physician, make sure he does not have a supplier number that he uses occasionally for billing DMEPOS services, or your application will be turned down.

Q: How do I find out what licenses, permits or registrations will be required to apply for a new number?

A: The NSC has a Web site with this information. Go to www.palmettogba.com/palmetto/Providers.nsf/Home/Providers+National+Supplier+Clearinghouse+Home?
OpenDocument.

Once you are on this site:

• Click on “Resources.”
• Click on “Licensure Information” twice.
• Scroll down to the “DMEPOS State License Directory.”
• Choose your state and you can see exactly what the NSC will be looking for.

Q: My supplier number has been deactivated because the NSC says I didn’t file claims. Since I do all my billing out of a central office, which Medicare says is okay, what’s going on?

A: You probably neglected to use the supplier number of the office where the service was rendered. If Medicare does not see any billings for four quarters from a specific supplier number, it will assume that location is no longer active and will deactivate that number.

While the NSC should have given you some notification of its intent to do this, that doesn’t always happen. Be sure to use all your existing numbers at least annually.

Q: My number has been deactivated because the NSC says that I didn’t renew my supplier number. Shouldn’t I have gotten some notification that it was time to renew?

A: Yes, you are supposed to be contacted by the NSC when your renewal is due. However, it is wise to also keep an eye on this date yourself, since mailings do go astray from time to time.

You are expected to renew your number every three years. If you have not heard anything and your date is getting close, contact the NSC to verify your renewal date.

We hope these answers clear up any confusion you might have about Medicare supplier numbers. If you have additional questions, please contact Kathy Dodson at (571) 431-0876, ext. 210 or kdodson@AOPAnet.org.

Kathy Dodson is the senior director of government affairs for the American Orthotic & Prosthetic Association (AOPA). Questions? Call (571) 431-0810 or visit www.AOPAnet.org.