Reimbursement

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Thursday, October 31, 2002

UPINs under scrutiny
WITH BRUCE BOTHIS
Q: What's all the hoopla regarding surrogate UPIN numbers?

A. A report from the OIG dated September 2002 sheds light on the rampant incorrect use of surrogate UPIN numbers. The report estimates that 61% of 1999 sample DMERC claims were incorrectly billed using a surrogate UPIN rather than the ordering physician's permanent UPIN. A similar 2001 OIG report concluded that 14,000 different invalid UPIN numbers were used in 1999 with a cost to Medicare of over $32 million while an additional $59 million was paid on claims containing 28,000 inactive UPIN numbers (rumored to include several deceased physicians).

What does this mean to you as a supplier? It means that CMS will be looking much harder at the UPINs you use. There are only five valid surrogate UPINs you can use if the physician does not have a permanent UPIN. They are:

- RES000 – use for residents, interns or fellows

- VAD000 – use for active duty or VA physicians

- PHS000 – use for physicians in the Public Health Service (includes Indian Health Service)

- RET000 – use for retired physicians that have not been issued a permanent UPIN

- OTH000 – use for physicians not assigned a UPIN or not qualified for a surrogate UPIN

A little tip from me to you: Do not use OTH000 as a crutch just because you are too lazy to find out if the physician has a permanent UPIN. There are many places to obtain this number: a simple phone call to the doctor's office, a CD-ROM produced by the U.S. Government Printing Office or the Internet. Don't let your cash flow be interrupted by this small but important piece of information!

Bruce Brothis is President / CEO of Centralized Billing & Intake. He can be reached at 800-396-9910.

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