For those who attended the 34th AUGS Annual Scientific Meeting, you may have heard information presented regarding the taxonomy code for Female Pelvic Medicine and Reconstructive Surgery (FPMRS). If you passed the FPMRS Board Exam, you will want to update your Medicare Enrollment and Private Insurance Contract Information to reflect this specialization.
Below are a few helpful FAQ’s that the AUGS Health Policy Committee has developed for members:
What are Taxonomy Codes? Healthcare Provider Taxonomy Codes are designed to categorize the type, classification, and/or specialization of health care providers. The Code Set is maintained by the National Uniform Claim Committee. The Code Set is a Health Insurance Portability and Accountability (HIPAA) standard code set. As such, it is the only code set that may be used in HIPAA standard transactions to report the type/classification/specialization of a health care provider when such reporting is required.
Why is it important to update your Healthcare Provider Taxonomy Code? As the Centers for Medicare and Medicaid Services (CMS) continues to implement the Value-Based Payment Modifier for physicians, physicians’ quality and cost, “scores,” will be compared to their peers. One way for the Medicare program to define peers could be by using taxonomy codes. Also, in the House Energy and Commerce Committee proposed legislation to repeal the sustainable growth rate (SGR), the proposed new payment system would be based on quality scores for physicians by cohort, with the cohort defined by ABMS approved specialties. A way to segment by ABMS approved specialties is to use taxonomy codes.
What is the Taxonomy Code for Female Pelvic Medicine and Reconstructive Surgery? Effective January 1, 2012, the National Uniform Claim Committee at the request of the American Board of Medical Specialties created a new healthcare provider taxonomy code to recognize the subspecialty of Female Pelvic Medicine and Reconstructive Surgery.
Taxonomy Code 207VF0040X Female Pelvic Medicine and Reconstructive Surgery
A subspecialist in Female Pelvic Medicine and Reconstructive Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them.
When health care providers apply for a National Provider Identifier (NPI) from the National Plan and Provider Enumeration System (NPPES), a health care provider must select the Healthcare Provider Taxonomy Code or code description that the health care provider determines most closely describes the health care provider's type/classification/specialization, and report that code or code description in the NPI application. If you passed the FPMRS Board exam, you can now amend your information with Medicare through their on-line system to reflect your new level of specialization. You may want to call those private insurance companies that you are on contract with to amend your contract to reflect this taxonomy code, as well.
For Medicare, the Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) can be used to update your enrollment information. Please visit the page of the Centers for Medicare and Medicaid Services (CMS) web site for the Internet-based PECOS system where there is a tutorial regarding how to use this system to update your Medicare provider and National Provider Identifier information (NPI).
Additional Tips for Updating your Information Healthcare Provider Taxonomy Code: Below is a link to the CMS website where you may update your National Provider Information (NPI). You may first have to visit PECOS to register and obtain a password/log in if you do not already have one.
Your Medicare contractor should also be able to assist you with updating your information. For private insurance, you will need to contact your provider representative listed in your contract with each insurance company that you are a contractor with and learn from them what forms you need to fill out in order to have your contract updated.
If you have additional questions, please contact AUGS at firstname.lastname@example.org or 202-367-1167.