Orthopedic Coding Alert

Start sharing NPIs now to avoid a crunch later

You have new National Provider Identifier (NPI) numbers for each of your physicians, but do you know what to do with them? Requesting the numbers was the easy part of the process, and now you-re faced with the hard part -- learning when and how to use the numbers.

Good news: You shouldn't expect the NPI implementation process to be complicated or difficult for your office. -If the NPI is set up correctly for the group, provider, etc., there should be no problems,- says Rebecca Marthaller, CMRS, owner of Lower Columbia Medical Billing in Longview, Wash.

Get to Know the Purpose of an NPI

Practices often get so caught up in the process of applying for an NPI that they don't stop to think what the NPI is meant to do.

An NPI is designed -- to uniquely identify a healthcare provider in standard transactions, such as healthcare claims,- according to CMS- Web site. NPIs may also be used to identify healthcare providers, CMS says, -on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways.-

As of May 23, you-ll have to use your NPI as the only provider identifier for claims you submit. -It is required that the NPI be on all claims for all carriers,- Marthaller says.

Be aware: Any healthcare provider is eligible to obtain an NPI number. Any provider who falls under HIPAA guidelines will need an NPI number -- this includes physician assistants and nurses.

Exception: The NPI compliance date for small health plans is May 23, 2008.

Notify Medicare of Your New NPI
 
You should let Medicare know about your new NPI in one of two ways, depending on whether you are a new or established Medicare provider:

 - For new Medicare providers, you should include your NPI on the CMS-855 enrollment application.

 - For your existing Medicare providers, you must provide their NPIs when you make any changes to your providers- Medicare enrollment information.

Remember: You should use your providers- NPIs, along with appropriate legacy identifiers, on all of the claims you submit to Medicare after the implementation date.

Group Practices Face Different Challenges

When you-re billing for a provider in a group practice, remember the following when it comes to NPIs.

First step: If you now have a group ID, you will need a group NPI. If you-re billing for a facility, you-ll need a facility NPI, Marthaller says. Each individual provider also needs his own NPI.

Pointer: For providers in group practices, enter the group number in box 33 on the claim form while entering the individual provider NPI in 24J, Marthaller says.