Pathology/Lab Coding Alert

Question: I-ve already started using my NPI number, but now my FI is telling me there's an upcoming NPI deadline, and I need to submit a new 855 form. What's going on?

Michigan Subscriber

Answer: Although you-ve already met the March 1 deadline after which CMS stressed that you would not get paid without a National Provider Identifier (NPI) number, you need to provide the requested information by the next key deadline.

That's May 23, by which date you must be able to submit Medicare claims with only the NPI in the primary fields. If your carrier has asked you to resubmit information on its 855 enrollment form, proceed with particular caution.

Here's why: If you haven't yet submitted a new 855, your intermediary may be paying your claims by virtue of a "temporary crosswalk match" that links your legacy number and NPI. But the intermediaries- upcoming maintenance of the provider enrollment system may soon throw a wrench into that temporary fix, leaving you in a situation with all claims suddenly rejecting.

To avoid this tripping point, get the 855 form in -- and communicate with your intermediary to ensure the system picks up the corrections quickly.

"Only correct information in the Medicare provider files will ensure that a match remains on the crosswalk, so we urge all providers to make the necessary corrections to their data," CMS said during a recent Medicare NPI conference.

Simply turning in the corrected 855 -- without following up with your Medicare carrier -- may not be enough. CMS has warned that the process of revising the enrollment data "can take a number of months to accomplish."

Resource: More information about NPIs is at http://www.cms.hhs.gov/NationalProvIdentStand.

-- Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.