CMS's Encounter Data Lack Essential Information That Medicare Advantage Organizations Have the Ability to Collect

National Provider Identifiers (NPIs) for physicians and nonphysician practitioners who order and/or refer services (ordering providers) are essential for safeguarding the program integrity of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS); clinical laboratory services; imaging services; and home health services in Medicare. NPIs are critical for identifying inappropriate billing and ordering patterns among providers and investigating fraud and abuse. Both CMS and OIG rely on NPIs for ordering providers to conduct oversight and pursue fraud investigations.