Orthopedic Coding Alert

Eliminate problems by following a few easy steps The switch to using National Provider Identifier (NPI) numbers within your practice doesn't have to throw a wrench into your claims process. You can smooth the transition with several quick tips.

One of the issues within NPI that causes confusion is that eventually the NPI is to handle the jobs of both the UPIN and the PIN. CMS and other payers have forgotten the confusion the UPIN caused, so it's quite possible that we will once again go through the same types of pain and confusion.

If you try to think about it in the same context as we do business now, you can help yourself to relax a bit. The first thing we need to do is remember that some of the NPI numbers are going to be used for getting paid. That is the equivalent of the PIN now and why you need to get an NPI for the entities that receive the reimbursements.

Then think of the fact that you need a UPIN to get a claim processed. Eventually that will also be the NPI for the individual practitioner. Not every payer has this clearly in mind, so as you read the answers to the frequently asked NPI questions below, keep in mind that these refer to what the answers should be based on CMS directives -- but are not necessarily what each payer wants. Double Up on Numbers At First Question 1: I read that I shouldn't submit just my NPI when I send in my Medicare claims -- I should use my regular PIN as well as the NPI number. Is this accurate, and if so, how long must I continue sending in both numbers? Answer 1: You read correctly. You should be using the PIN and the NPI for the entity that will be reimbursed until you and your payer are confident that things are working. Some payers will require that you submit your claims that way until May, but some payers may ask you to submit the claims that way even longer.

You should also know that CMS discovered a printing error in the Government Printing Office version of the CMS-1500 form templates and has delayed final official implementation of the NPI until probably July. Protect the NPI -- or Share It? Question 2: I have been told to protect my NPI, and I have been told to share it -- how am I to protect my NPI if I must share it with others? Answer 2: A good question without a really good answer. The best answer is -share it carefully.-

CMS says, -Healthcare providers must protect their NPI because providers are eligible for only [...]