Medicare Compliance & Reimbursement

Get ready for denials if you're not geared up for the National Provider Identifier (NPI) requirements that hit May 23.

"As of May 23, Medicare FFS will require and send NPI-Only in ALL provider identifier fields for all HIPAA and paper transactions where a provider identifier is required," CMS warned on the eve of the deadline. "If you send Medicare a transaction with a Medicare legacy identifier in any of the provider fields, your claim will be rejected," CMS said.

And you won't be off the hook for leaving referring physicians' NPIs off the claim. If the physician "does not furnish an NPI, the billing provider must attempt to obtain that NPI in order to enter it on the claim," CMS reminds providers. Use the NPI registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do or contact the physician directly for the NPI number in question.

To use your own NPI in the secondary field, you must have "exhausted all possibilities of finding the NPI" of the referring or prescribing physician, CMS directs.

• Medicare has awarded 325 competitive bidding program contracts for durable medical equipment.

In its May 19 announcement, CMS seemed to indicate that the program, which goes into effect on July 1 in 10 communities, will not drive small suppliers out of business, as previously speculated.

"Bids were evaluated to ensure there would be a sufficient number of suppliers, including small suppliers, to meet the needs of beneficiaries living in the competitive bidding areas," the release noted.

For more on the program, go online to the Web site http://www.cms.hhs.gov/DMEPOSCompetitiveBid.

• If you're one of the lucky participating states, you can check out how your claims data compares to your peers in the same specialty and geographic location.

Empire Blue Cross/Blue Shield, a Part B carrier in New York and New Jersey, is offering practices a comparative distribution report (CDR) to benchmark their E/M use with other physicians'.

If you're in one of these two states, you can email your CDR request to eastclinicaleducation@wellpoint.com, along with your PIN, your practice address and phone, and the code family you're requesting.