Medicare Compliance & Reimbursement

Gear up for a rough transition to NPI-only claims. That's the lesson to take away from a recent Medicare National Provider Identifier conference.

There is some good news, according to the Centers for Medicare & Medicaid Services (CMS). "We are proud to report that 99.87 of all Part A claims now have an NPI," said a federal official speaking at the Feb. 6 CMS-sponsored call.

But temper that with the news that some claims, particularly Part B, are still coming to contractors with no NPI. And CMS and others are saying that the most problematic stretch in the transition likely lies ahead.

"We're not hearing about a lot of problems yet, but we may just be too early in the process," cautions consultant Bobby Dusek of Abilene, TX, echoing the concern of other experts.

CMS officials speaking during the call cast the spotlight on the "enrollment challenges" that providers would need to address before moving smoothly to the next stage in the transition.

Deadlines: 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.

Trouble ahead: Providers that have been asked to resubmit information on their 855 enrollment form should 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, A/B MAC, or DME MAC -- may not be enough. CMS has warned that the process of revising the enrollment data "can take a number of months to accomplish."

Software snag: Another problem that came to light during the call involves a software glitch.

One Kansas City-based hospice provider trying to test NPI-only claims called in, saying that her PC-ACE Pro 32 software, used by providers in Kansas, Nebraska, Missouri and part of New York, would not allow her to take out the legacy number.

Band-aid: "We've since talked to [software administrator Administrative Services of Kansas]," caller Malia Renfro of Kansas City Hospice & Palliative Care said. The solution is to enter the NPI in the legacy number field, so that the NPI overrides the old number.

Other providers may have similar problems with their own software, experts caution. So don't leave it until the last minute to find out.

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