Medicare Compliance & Reimbursement
You Have Until May 2008 To Include Referring Docs' New Numbers
But new drop-dead NPI deadline may be as soon as July. Important: Providers not in full compliance with the NPI requirement must have a contingency plan by May 23 when the NPI deadline hits, CMS stresses.
That wiggle room you're supposed to have on National Provider Identifiers (NPIs) just got a little tighter.
The Centers for Medicare & Medicaid Services (CMS) announced earlier this month that because providers and other covered entities aren't ready to use NPI numbers on their Medicare claims, it was extending the NPI deadline for a year.
Limit: But now CMS says you may have to have your own providers' NPIs on claims as early as July. "As soon as the number of claims submitted with an NPI for primary providers ... is determined sufficient ... Medicare will begin rejecting claims that do not contain an NPI for primary providers," CMS says in MLN Matters article MM5595.
Primary providers for NPI purposes are "billing, pay-to and rendering providers," CMS explains.
What's next: In May, CMS will assess how many providers are submitting claims with NPIs. If the ratio is high enough, it will start requiring NPIs from all
primary providers in July, the article says. If the ratio isn't yet high enough, it will reassess in June for an August implementation.
Off the hook: You don't have to furnish referring physicians' NPIs on claims until May 2008. Providers can include "secondary" providers' legacy numbers, including UPINs, on Medicare claims until that date.
If you find some referring physicians aren't providing you with their NPIs, you could forward a copy of CMS' March NPI FAQ that explains that providers should share their NPIs with other providers, suggests attorney Deborah Randall with Arent Fox in Washington, DC.
You could also try to obtain NPIs for referring physicians from other providers who work with them, such as hospitals, suggests consultant Pam Warmack with Clinic Connections in Ruston, LA.
Resource: The MLN Matters article is at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5595.pdf.
Medicare Compliance & Reimbursement
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