Medicare Compliance & Reimbursement
At Last, NPI Requirements Are Getting Clearer
Your providers should already have their own national provider identifiers (NPIs), officials from the Centers for Medicare & Medicaid Services (CMS) told a May 10 special open door forum on NPI issues. Even if you obtain a contingency plan, you still may be required to have NPIs for all providers as soon as July 1.
But when it comes to listing the provider number of a referring physician, you have much more leeway. You have until May 2008 to include NPIs for referring physicians. Until then, you can keep using unique provider identifier numbers (UPINs) for referral sources, CMS officials said.
CMS punted yet again regarding the agency's ability to link providers with the NPIs of referring physicians and other providers as necessary. CMS officials announced early in the call that they wouldn't address questions relating to the long-delayed data dissemination plan, saying the agency would release additional information as soon as possible.
You can get more information at www.cms.hhs.gov/NationalProvIdentStand. You can also contact the NPI enumerator directly (1-800-465-3203), but only to check on specific concerns, such as the status of your application, or a lost NPI.
Providers should look for contingency plan information "from various health plans they bill and with whom they conduct any HIPAA transaction," said a CMS official speaking at the forum. That includes CMS' other health plans, such as Medicare Advantage, Medicare Part D and state Medicaid plans.
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