Part B Insider (Multispecialty) Coding Alert

Published on Sun Feb 11, 2007 PDF

You'll have 'guidance' by deadline, CMS promises

Heads up: There are just about two months left until the May 23 deadline to start using national provider identifiers (NPIs)--and the new system isn't quite ready for prime time.

Problem #1: Most providers still haven't tested out billing with an NPI, Centers for Medicare & Medicaid Services (CMS) officials told the March 5 meeting of the Practicing Physicians Advisory Council. By now, 80 percent of known providers have obtained an NPI, but only 20 percent are -actively implementing- the numbers in billing.
This means most physicians need to get with the NPI billing program within the next month, or risk delays in payment, CMS officials noted.

Problem #2: CMS still hasn't explained how you-re going to get the NPIs for doctors and other providers with whom you do business. Starting May 23, you-ll have to list the NPIs for doctors who refer patients to you--or expect denials.

CMS has been promising for years to issue a -Data Dissemination Notice- that would explain how to obtain the NPIs of other health care providers. But CMS has been dragging its feet and stonewalling, physician advocates complain. As far back as April 2006, the Workgroup for Electronic Data Interchange (WEDI) warned that any further delays in the publication of this notice would endanger providers- ability to meet the May 2007 deadline.

CMS finally sent this all-important notice to the Office of Management and Budget (OMB) for clearance on Feb. 26, says Martin Jensen, a consultant with Healthcare IT Transition in Tulsa, OK. Once the OMB approves the Notice, it can appear in the Federal Register--but the OMB could take up to 90 days to approve it, or until late May.

Broken record: When callers to the March 6 physician Open Door Forum asked questions about NPIs, CMS officials answered that the delayed Data Dissemination Notice would explain everything. One caller demanded how billers should handle referrals from doctors who haven't yet obtained an NPI, and CMS referred her to the Notice.

For now, the only way to obtain the NPIs of doctors you do business with is to contact them one by one, CMS officials said. But they promised that this confusion won't keep you from getting paid. -We-ll have guidance out there that will enable something to be put into that [referring physician] field so that your claims can get processed,- one official promised.

Privacy conundrum: The problem with setting up an NPI-sharing database is that NPI data includes a physician's home address and social security number, explains Jensen. So doctors fear identity theft or more junk mail if this information is too easy to access. -You may want your own number to be private but you absolutely need everyone else's to be public,- he says.

At its meeting, PPAC resolved that CMS should find a way to prevent people from being able to buy lists of doctors- NPIs, and make sure only people with a legitimate need for the numbers can access them.

Problem #3: Wisconsin Medicaid won't be ready to accept NPIs by May 23, warned Mary Peterson from Mile Bluff Clinic in Mauston, WI. So when a patient has both Medicare and Medicaid coverage, the claims won't cross over automatically from Medicare to Medicaid. The only solution would be for Medicare to continue to pass along the legacy numbers to Medicaid.

Other Medicaid programs may not be ready for the May deadline either, Wisconsin officials have told Peterson. If Medicare doesn't continue to provide legacy numbers to Medicaid programs, then Mile Bluff will have to resubmit every single Medicaid claim on paper, Peterson tells PBI. Since the clinic has already geared its computer systems to produce only NPI numbers after May 23, this could be an administrative nightmare.

CMS officials promised to get in touch with Peterson about this issue, but hadn't done so at press time.