Industry Notes:
YOU CAN LOOK UP REFERRING DOCS' NPIs IN DATABASE
Published on Mon Aug 27, 2007
NPI edits cause billing headaches.
Warning: Don't remove all of your legacy numbers from the National Provider Identifier database. If you do, Medicare and other payors may have a hard time finding you and that could delay your payments.
When the NPI database comes out on Sept. 4, payors will be looking up their providers according to those legacy numbers, officials from the Centers for Medicare & Medicaid Services told an Aug.14 physician Open Door Forum.
"If you remove your legacy numbers from the 'Other Provider Identifier/Other Provider Identifier Type Code' fields, linkages that Medicare has established using the reported Medicare legacy numbers will be broken and your Medicare claims could be rejected," CMS warns in a message to providers.
The old problem: Providers had until Aug. 20 to remove sensitive data like Social Security Numbers from the NPI database. Some providers wrote their SSNs in the NPI database in the "other provider numbers" field. You're supposed to use this field to list your legacy numbers.
The new problem: CMS advised providers to remove SSNs from those fields to avoid their public release in the NPI database. But then some providers just erased all numbers from that field.
"The reporting of legacy numbers ... will assist Medicare in successfully creating linkages between providers' NPIs and the identifiers that Medicare has assigned to them," CMS says in the release.
But even correct NPIs can cause you billing headaches. Claims submitted after Aug. 17 with valid NPIs were going to Return To Provider (RTP) locations in error, report regional home health intermediaries National Government Services and Cahaba GBA. "Several provider records that originally matched with our provider file became unmatched, causing claims to go to RTP incorrectly with reason codes 32103, 32104 or 32105," Cahaba explains in an email to providers.
Do this: The problem has been resolved, Cahaba says. But if you submitted claims via file batch transfer that were rejected with those codes, you need to resubmit them, Cahaba instructs.
About 30 percent of NGS providers saw rejected claims due to the NPI problem, the RHHI says. • Two operators of a New York home health agency have pled guilty to Medicaid fraud in an industry-wide crackdown in that state. Nachem Singer and Ervin Rubenstein of Immediate Home Care Inc. in Brooklyn bilked the program of $12 million, alleges New York Attorney General Andrew Cuomo in a release.
The pleas are the first from HHA owners in "Operation Home Alone," the probe of fraudulent home care aide certifications. Immediate's revenues increased from $3 million to $52 million from 2003 to 2006, the release notes. Immediate employed uncertified aides, recruited aides from training facilities where false certifications could simply be purchased, billed for services never rendered, and billed for services [...]
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