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 one NPI -- the goal is to enable providers to retain one NPI for life to simplify many administrative functions and data exchanges with other organizations.

-It is also true that covered healthcare providers must share their NPIs and those of their subparts with entities that need those identifiers to identify them in standard transactions (as adopted under the Health Insurance Portability and Accountability Act of 1996 -HIPAA-). Through careful planning and coordination with trading partners and business associates, providers should be able to both protect their NPI and share it appropriately to conduct standard transactions.-

For detailed statement from CMS, see the site www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPIdisclosures.pdf.

Send Letters to Payers

Question 3: We were told that we have to supply our NPI numbers to every insurance company that we deal with. We submit claims to over 400 insurance companies. How can we get our NPI numbers to all of these insurers before the upcoming NPI implementation date?

Answer 3: This is another common complaint, and there is no good answer. You are required to share your NPI with clearing houses, other providers, health plans, and any other entity that needs it for billing. One way that
some find successful is to send a letter to each payer address in your computer.

The latest news is that CMS will set up a databank so that the numbers will be available. Apparently, folks see this like credentialing where you have to set up each MD with each payer.

Organize Inter-Office NPIs

Question 4: We have a physiatrist who comes to our practice just one day per week on a contract basis, but we bill out his claims as we do for all of our staff surgeons. Should we get an NPI for this physician, or should we use the NPI that he has from his regular practice?

Answer 4: You will use his NPI from the other practice and your PIN/NPI in box 33.

Compile NPIs for Various Addresses

Question 5: We applied for NPI numbers for all 18 of our physicians, but because we also operate an ASC, should we get an NPI number for that facility as well?

Answer 5: According to CMS, yes, you should get an NPI for that facility as well. You should definitely get one for every address that you expect payments to be sent to.

Ask for Referring Physicians- NPIs

Question 6: My understanding is that I have to list an NPI for every physician who refers a patient to me. How do you suggest that I get all of these NPI numbers from other practices?

Answer 6: You would get this information the same way you get UPINs -- you will have to ask the referring
physicians for their NPIs. If a databank is eventually set up by Medicare or your individual carrier, you-ll be able to use that.

For more information on NPIs, visit www.cms.hhs.gov/NationalProvIdentStand/.

Quinten A. Buechner is the president of ProActive Consultants Inc., a practice management consulting firm based in Cumberland, Wis.