Ophthalmology and Optometry Coding Alert

CMS admits defeat, promises progress on NPI-sharing   Good news: You'll have an extra year to prepare your national provider identifier (NPI) compliance.      
Bad news: The extension may not be as great as it sounds, and you may not be able to, or want to, take advantage of it.   Sort Through the Deadline Confusion    Better safe than sorry: Although CMS has said it will give you an extra year's wriggle room on NPIs, other payers can start requiring them in May 2007.      
"The current language of the policy does not give an extension to providers," says Kyle L. Thomas, founder of Great North Provider Services in Anchorage, Alaska. "If CMS is granting an extension to everyone (including providers), then they need to re-issue the policy with a clarified definition."      
Limit: CMS says you may need to have your own providers' NPIs on claims as early as July of this year. "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 says.   Providers Aren't at Fault   With less than two months left before crunch time, CMS decided to give you until May 23, 2008, to become NPI-only with all of your transactions. If you're not quite ready by May 23, 2007, you can implement a "contingency plan" to maintain your cash flow, CMS said in a release.      
Why the change: CMS tried to imply that providers weren't ready for the original deadline. But CMS was also behind on its obligations, said the Medical Group Management Association (MGMA). CMS failed to issue a policy that would "facilitate the communication of NPIs," said MGMA President and CEO William Jessee in a release.      
Without any CMS policy, providers didn't know how to obtain the NPIs of physicians who referred patients to them. The MGMA has posed a sample letter to request a referring doctor's NPI on its site at www.mgma.com, but CMS has been promising a "Data Dissemination Notice" on NPI-sharing for years now.      
The lack of this CMS policy has "hindered industry efforts to meet the original compliance date," MGMA said.      
To come: CMS promises it will soon make data available to help you develop "crosswalks" between old provider numbers and NPIs.      
Another reason for the extended deadline is that some non-Medicare third-party payers and clearinghouses are not ready for this year's deadline either, experts say.   Contingency Plans Are Key   CMS hasn't actually suspended the original May [...]