Medicare Compliance & Reimbursement

Don't let out-of-date software keep you from using NPIs.

A patch could keep your billing software from poking massive holes in your reimbursement.

Problem: The current version (V11) of MediSoft's billing software has a field for the national provider identifier (NPI), but it's not tied to any report or claim file, says Cyndee Weston with the American Medical Billing Association. MediSoft has promised to come out with a free update to its current version to accommodate the new version of the CMS-1500 billing form.

But for now, providers using this software have to rely on the clearinghouse to "hard key" the NPI so it'll appear in the right place on all future claims, says Weston. "This is something the clearinghouse would do on their end," she adds. That's also what the clearinghouse will have to do, if you're using older or out-of-date software, she explains.

"If a change needed to be made to the NPI, it would have to go through the clearinghouse," Weston warns. "The user would not be able to make that change."

If MediSoft doesn't put out the update to V11 as promised, then users may have no choice but to upgrade to V12, which is due out in March 2007. "That's cutting it very close," Weston notes.

Warning: Some software vendors are pushing physician offices to upgrade their software completely, instead of just updating existing software, says Kyle Thomas with Medical Park Family Care in Anchorage, AK. This could be a huge unexpected expense for offices which invested in new software just a year or two earlier, he warns.

Tip: Make sure your vendor schedules some testing to ensure not only that the NPI works, but also that it appears where you want it to on the claim form. You should also make sure it's compatible with your vendor's interface, says Betsy Hill with Pacific Women's Center in Eugene, OR.

Other payors: Keep track of whether other payors, such as managed care plans or your state's Medicaid program, are ready for NPIs and when they'll start requiring them.

"The commercial insurances still have not really notified us of any time tables, and when I call I get told that a mass-message will come out as soon as they figure out what to do," says Susan Stratton with Seabreeze Medical Billing and Collection.

Ideally your carriers should notify you, but this may not happen. If you use a billing clearinghouse, it should be the clearinghouse's responsibility to keep track of which payors are up to speed with NPIs, says Stephanie Fiedler with Park Avenue Health Care in New York. "You have to know your carrier, and then if they are notoriously poor communicators, contact their provider enrollment staff," she advises.

Tip: Keep a spreadsheet listing each payor, when the payor will require NPIs, the date you faxed your NPI information to the payor and the contact person you faxed the information to, Hill advises.

Referring physicians: You need to have the NPIs of all physicians who refer patients to you, or you won't be able to list the referring physician on claim forms after May. At the moment, there's no online resource to look up a physician's NPI, notes Thomas.

"Our clinic uses a preprinted form that referring physicians complete when they send patients to us," says Nancy Klein, a coder with Matrix Pain Management in Saginaw, MI. She's updating this form to include a request for the referring doctor's NPI.

Tip: If your software includes a database of referring doctors, add each doctor's NPI as an "other information" category, recommends Thomas.

If you belong to an independent physician association (IPA), then ask whether it will compile a database of all its members' NPIs, Hill advises.