Medicare Compliance & Reimbursement

Sound a loud warning if your billing office is behind in moving toward NPI-only billing for Medicare, especially if you're still sending -- and being paid for -- claims that include only your Medicare legacy number.

No. 1 problem: Some home health agencies and other providers submitting legacy-number-only claims have yet to get a warning from their intermediary or contractor that things are about to change. That could make it seem as though you have no NPI worries, but that's far from the truth.

"You should be receiving informational messages [from your intermediary] if you are submitting claims with the legacy number only," cautioned a Centers for Medicare & Medicaid Services (CMS) official speaking at the recent NPI-focused Q&A call on Feb. 6. "Ask your clearinghouse if you are not getting these [error] messages."

End of the ride: Starting March 1, Medicare won't pay providers for any claim submitted without an NPI -- even if your intermediary or contractor has been letting claims sail through.

During the Q&A call, CMS also issued these warnings about common NPI mistakes.

• Make sure your numbers agree. "We are still receiving claims with a group NPI and an individual legacy number at the primary provider level," cautioned the agency. "This is not a valid combination and it will reject."

• Make sure the information in the National Plan and Provider Enumeration System (NPPES) matches the information on your enrollment form.

• If you are a DME supplier and a sole proprietor, make sure you obtained your NPI properly and that you reported your legacy ID to NPPES in the correct field, reiterated CMS during the call. If you have a Social Security number in NPPES and an Employer Identification Number on file with the National Supplier Clearinghouse, your NPI/legacy numbers will not match and your claims won't pay, the official warned.

Best advice: "Pay attention to information from Medicare contractors and CMS," one agency official stressed during the call.