Medicare Compliance & Reimbursement

Despite CMS' frequent reminders, many Medicare-participating physician groups have not yet acquired National Provider Identifier (NPI) numbers.

During a recent Medicare NPI conference, CMS officials noted that 99.87 percent of all Part A claims now have an NPI, but that Part B providers haven't caught up just yet.

Starting March 1, "you will not be able to get paid for any Medicare services you provide until you begin using your NPI," CMS stressed in a recent e-mail message to providers.

The other key deadline is May 23. By that date, you must be able to submit Medicare claims with only the NPI in the primary fields. If your carrier has asked you to resubmit information on its 855 enrollment form, proceed with particular caution.

Here's why: If you haven't yet submitted a new 855, your intermediary may be paying your claims by virtue of a "temporary crosswalk match" that links your legacy number and NPI.

But the intermediaries' upcoming maintenance of the provider enrollment system may soon throw a wrench into that temporary fix, leaving you in a situation with all claims suddenly rejecting.

To avoid this tripping point, get the 855 form in -- and communicate with your intermediary to ensure the system picks up the corrections in a timely manner.

"Only correct information in the Medicare provider files will ensure that a match remains on the crosswalk, so we urge all providers to make the necessary corrections to their data," coached CMS during the call.

Simply turning in the corrected 855, without following up with your Medicare carrier, may not be enough. CMS has warned that the process of revising the enrollment data "can take a number of months to accomplish."

Resource: More information about NPIs is at http://www.cms.hhs.gov/NationalProvIdentStand.

In Other News ...

• You can curb a confusion that you had regarding the Zostavax vaccine for shingles. Empire Medicare, a Part B payer in New Jersey and New York, recently disseminated a clarification that reminds practices that Zostavax is "excluded from Medicare Part B coverage," but may be payable under Medicare Part D.

If you still have claims for dates of service in 2007, you can still submit them to your Part B payer using G0377 (Vaccine administration for Part D drug), but 2008 claims should go to Part D.

Read the clarification at http://www.empiremedicare.com/news/nynews08/021808zos.htm.