Medicare Compliance & Reimbursement

Extra NPI leeway may be a trap--Watch for this glitch.

You now have an extra year to get up and running with national provider identifiers (NPIs). But you might want to send that particular gift back to the store.

Better safe than sorry: Even though the Centers for Medicare & Medicaid Services (CMS) has said it will give you an extra year's wriggle room on NPIs, other payors can start requiring them in May 2007, according to Martin Jensen, chief operating officer and chief analyst with Health IT Transition Group in Tulsa, OK.

"It's already happening," Jensen says. "Delaware's Medicaid program instituted an NPI-only system last week. Providers were warned, but they weren't prepared." But other Medicaid programs have said they won't be ready to accept NPI numbers this May at all.

"I'm not having my providers take any chances," says Kyle Thomas, founder of Great North Provider Services in Alaska. "If my providers get a letter from CMS wanting to know why they need to be in contingency and find out that I let them get behind the curve, then that reflects badly on my company."

Doctors "want this over with," adds Thomas. It would be "ill-advised" to say, "Well, we could probably take another year to get things in order," he says. "I'd rather be over-prepared" than unprepared, he concludes.

One way or another, you'll have to face "a large number of initial electronic claim rejections," Thomas warns. Some health plans are already asking providers to keep including legacy numbers as well as NPIs on all claims. Others, like Part B carrier Noridian, still haven't explained their electronic claim requirements.

"The largest headache is going to come when we have to format our claims with our clearinghouse so they send the correct information to the insurances," Thomas laments.

Hitch: Providers can't be fully prepared for NPIs until CMS explains how they can obtain the NPIs of referring physicians, Jensen warns.

And some of your referring physicians may not even have NPIs this summer, now that they know they have another year to obtain them. Some providers are holding off obtaining NPIs until they know how CMS plans to share them, Jensen adds.

If you've already set up your billing systems to use only NPIs, you may have some headaches dealing with payors and other providers who won't be ready, Jensen notes. The biggest challenge for system designers occurs "when multiple trading partners move between different stages of compliance according to their own independent schedules."

Bottom line: It pays to be ready by the original May 2007 compliance date--but don't expect everybody else to be ready too.