Home Health & Hospice Week

If you haven't applied yet, you could be on CMS' bad list.

Providers have an extra 12 months to get into compliance with National Provider Identifier rules--but only if they have a good reason.

The Centers for Medicare & Medicaid Se-vices indicates in a recent NPI Frequently Asked Ques-tion that it won't go easy on providers who slack on NPI requirements.

In response to a question about what CMS wants to see in an NPI contingency plan, the agency says it will "assess whether covered entities have exhibited diligence and good faith efforts towards compliance."

An important part of doing that is applying for a number. "Providers that have not yet obtained NPIs, should do so immediately," CMS instructs. "Failure to obtain an NPI may be viewed as a violation of the good faith provisions of CMS' contingency guidance."

A break: CMS will investigate NPI violations only when it receives a complaint, the agency adds.

Experts recommend you take these steps now to steer clear of NPI trouble:

1. Apply for your own number. As CMS stresses, you should have applied for your own NPI already. "If [providers] haven't, they should make extraordinary efforts to do so," advises attorney Deborah Randall with Arent Fox in Washington, DC.

"Apply right now!" urges Burtonsville, MD-based attorney Elizabeth Hogue.

Document: And don't forget to record your application efforts, advises consultant Pam Warmack with Clinic Connections in Ruston, LA. "Document with dates and times each action taken towards securing a number," Warmack says. If you fail to secure a number for a particular reason, you should document the names of individuals you have contacted in an attempt to rectify the problem.

2. Draft your contingency plan. If you're not completely in compliance with NPI rules, which means using referring physicians' NPIs instead of UPINs on all claims by May 23, you must have a contingency plan stating how and when you will come into compliance.

CMS' guidance on what makes an acceptable contingency plan is maddeningly vague. "CMS guidance rarely leaves room for anything but confusion," Warmack laments.

In response to the contingency plan question, CMS says it "will not routinely make judgments nor approve contingency plans."

"It is virtually impossible to determine what CMS will regard as due diligence and good faith effort," Hogue judges.

Helpful: But there are some clues in CMS' guidance. To comply with the "diligence and good faith" language CMS uses, plans should include evaluating the provider community with which they need to share information to determine their level of readiness and willingness to share NPIs, counsels attorney Marie Berliner with Lambeth & Berliner in Austin, TX. And contacting other providers directly should be in the plan.

"The plan must be substantive and supported by actual documentation of the efforts made," Berliner adds. And be sure to actually undertake the actions you outline in your plan. (For more advice on what to include in your contingency plan, see Eli's HCW, Vol. XVI, No. 13).

3. Reach out to docs. As part of your contingency plan, you should outline the process for trying to obtain physicians' NPIs.

"HHAs should have a procedure [to request NPIs] connected with both their 485 and care plan communications with physicians, and their billing office's preparation of the Medicare billing paperwork," Randall counsels. Then make sure to record the NPIs in your systems and records so you can use them subsequently.

Your plan documentation can include things like copies of letters you have sent to physicians, Berliner suggests.

4. Capitalize on the physician communication. If you find some physicians aren't providing you with their NPIs, you could forward a copy of CMS' March NPI FAQ that explains that providers should share their NPIs with other providers.

Along with the FAQ, you can include a "polite comment that everyone needs to be responsive to this new obligation/burden and that the HHA will not pester the doctor for his/her NPI once received," Randall proposes.

Marketing moment: You can use this necessary point of communication to strengthen your relationship with the doc. That's what some Kentucky HHAs are doing, reports Karen Hinkle with the Kentucky Home Health Association. They "are using this as an opportunity to provide important information to referring physicians, taking advantage of an opportunity to be informative."

"Home care providers could serve as an information resource for physicians needing assistance with applying for NPI numbers," Warmack adds.

5. Approach other providers for doc numbers. There's no reason you can't obtain physician NPIs from other providers using it. "Since CMS encourages the sharing of NPIs between providers, perhaps home care providers could approach hospitals or participating clinics for needed NPI numbers," Warmack says. "Maybe even pharmacies."

Or if you are hospital-affiliated, you can enlist your hospital's influence in obtaining the numbers. One Montana hospital-affiliated agency "said that without help from its hospital partners ... it would have been much more troublesome to get all the docs' NPIs," Blumenthal tells Eli.

Note: The NPI FAQs are at www.cms.hhs.gov/NationalProvIdentStand/ --scroll down to "Related Links Inside CMS" and click on "NPI Frequently Asked Questions (FAQs)". The NPI page also includes CMS' contingency plan guidance and other NPI documents.