Dermatology Coding Alert

Start sharing those NPIs now to avoid a crunch in May

You have new National Provider Identifier (NPI) numbers for each physician you bill for, but do you know what to do with them? Requesting the numbers was the easy part of the process, and now you're faced with the hard part -- learning when and how to use the numbers.

Good news: You shouldn't expect the NPI implementation process to be complicated or difficult for your office. "If the NPI is set up correctly for the group, provider, etc., there should be no problems," says Rebecca Marthaller, CMRS, owner of Lower Columbia Medical Billing in Longview, Wash.

Take a look at these expert answers to your top NPI questions to ensure that you're up-to-speed in time to start using them in May.


Question 1: What's an NPI for, and when do I need to use it?

An NPI is designed "É to uniquely identify a healthcare provider in standard transactions, such as healthcare claims," according to CMS' web site. NPIs may also be used to identify healthcare providers, CMS says, "on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways."

As of May 23, you'll have to use your NPI as the only provider identifier for claims you submit. "It is required that the NPI be on all claims for all carriers," Marthaller says.

Be aware: Any healthcare provider is eligible to obtain an NPI number. Any provider who falls under HIPAA guidelines will need an NPI number �' this includes physician assistants and nurses.

Exception: The NPI compliance date for small health plans is May 23, 2008.

Question 2: Do I need to notify Medicare of my new NPI?

Yes, and here's how:

• For new Medicare providers, you should include your NPI on the CMS-855 enrollment application.
• For your existing Medicare providers, you must provide their NPIs when you make any changes to your providers' Medicare enrollment information.

Remember: You should use your providers' NPIs, along with appropriate legacy identifiers, on all of the claims you submit to Medicare after the implementation date.

Question 3: As part of a group, should we watch for additional things?

When you're billing for a provid-er in a group practice, remember the following when it comes to NPIs.

First step: If you now have a group ID, you will need a group NPI. If you're billing for a facility, you'll need a facility NPI, Marthaller says. Each individual provider also needs his own NPI.

Pointer: For providers in group practices, enter the group number in box 33 on the claim form while entering the individual provider NPI in 24J, Marthaller says.

Question 4: Do I need other physicians' NPIs for referrals?

Starting in May, you could have to list the NPI for every physician who refers patients to you. Will you be ready?

CMS hasn't yet decided whether it will require you to list NPIs for all referring providers in May, CMS official Jim Bossenmeyer told the Jan. 23 physician Open Door Forum (ODF). But it makes sense to prepare for this possibility, experts say.

Foot-dragging: CMS promised to issue a "dissemination notice" last fall explaining how you could obtain the NPI for doctors you do business with. But Bossenmeyer said this document is "still in clearance" and he can't predict when it will come out.

The concern: Providers at the ODF expressed concern that if they share their NPIs too widely, they could open the door for a fraudulent provider to bill under their numbers. But if they don't share their NPIs, they could have trouble billing soon. CMS officials didn't really have an answer for this conundrum.

Asked whether you're required to share your NPI with other insurance companies, CMS officials said, "You're encouraged to share your NPI with trusted partners," but not required to do so.

Clarification: CMS officials did clarify that solo practitioners need to apply for only one NPI, even if their practice is incorporated.