The Final Countdown to the NPI — BE PREPARED!

By Ronald E. Nyman, Esq.

As many of you know, May 23rd is an important date to all of us who handle billing for healthcare providers. After this date, which is a government mandated deadline, all providers must submit claims with National Provider Identifier (NPI) numbers. According to a recent report from the Center for Medicare and Medicaid Services (CMS), more than 1.6 million providers already have an NPI. For those of you who have not yet obtained yours, I recommend that you not delay a moment longer, as the deadline is closer than you think. For those of you who have an NPI, here are some additional items to add to your checklist:

1. Order Claim Forms: On April 2nd, all claims submitted on paper must be printed on the new CMS-1500 form that has additional spaces for NPI numbers. Medicare, along with many commercial carriers, will require you to submit claims on these forms after April 2nd. Therefore, you should order a supply now and keep them handy for use after this date.

2. Inform Carriers of Your NPI Number: For those of you who thought your work was done after you got your NPI number, think again. You now need to inform all the carriers of your NPI number, so they can perform the necessary crosswalks between your legacy numbers and the new NPI number. For Medicare and Medicaid, many of you already did this when you applied for your NPI at the National Plan & Provider Enumeration System (NPPES) website by giving your Medicare and Medicaid legacy numbers. However, if you did not do this when you got your NPI, you need to go back to the NPPES and input these numbers. As for commercial carriers, several will allow you to provide your NPI number through their websites. If you are unclear as to how to inform a particular carrier, I recommend contacting that carrier’s credentialing department.

3. Collect Referring Providers NPIs: This is fast becoming one of the most acrimonious issues regarding the rollout of the NPI program. Evidently, the government had neither plan nor provision for a national directory of NPI numbers. This omission presents a serious problem to doctors such as radiologists and surgeons who depend on referrals, because they will need the referring doctors’ NPIs when billing out consultations. Unfortunately, it is now incumbent on the provider who receives referrals to contact all other providers who frequently refer patients and obtain their NPI numbers. The implications of this problem are huge, as many claims will be denied if they do not have the referring providers’ NPI numbers.

And do not forget, if you are a group practice, the group itself must have an NPI number in addition to an NPI for each individual provider.

It will be interesting to see how smoothly we roll into and away from the May 23rd NPI deadline. I highly recommend following the Boy Scout adage when planning for a date as significant as this one — Be Prepared!

This article first appeared in the February 2007 issue of MediStar Meducation Alert^SM, the MediStar online newsletter.