Part B Insider (Multispecialty) Coding Alert
ALL ABOUT NPIs
The HIPAA deadline to use NPIs is May 23, 2007, but providers should be able to apply for NPIs by May 23, 2005, according to Walter Suarez, president and CEO of the Midwest Center for HIPAA Education in Bloomington, MN. Suarez predicts a rush to obtain NPIs once they become available. He lauds the convenience of having a single number for all payors. But the carriers will definitely undergo another massive adjustment when they try to move over to NPIs, notes Suarez. It's unclear how the carriers will obtain the new numbers from CMS or the providers. Their systems "will have to be adjusted to accommodate the new numbers." We're awaiting "some additional guidance from the office of HIPAA standards on how that will happen," says Suarez. But it's clear the carriers will have to "reconfigure their identification system" and "make sure there's a match process inside the system, so when the provider sends the bill with the old number, they can identify the new number."
And NPIs will bring their own kind of complexity. For a clinic group that has 20 locations and 150 individual physicians, there will have to be an NPI for each location as well as each physician, predicts Suarez.
In terms of billing, you'll probably need multiple NPIs to fill out the CMS 1500 form, claims Suarez. You'll need to put the NPI of the provider (clinic group) that is billing into box #33 of the 1500 form, but the NPI of the individual location into box #32 of the 1500 form, and the NPI of the individual physician into box 24-K. Thus it will be necessary to obtain numbers for all three levels. "The payor needs to be able to identify the location where the service was performed," notes Suarez.
Part B Insider (Multispecialty) Coding Alert
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