Eli's Rehab Report

Published on Sun Apr 27, 2008 PDF

Tip: Take stock of your enrollment status now

Gear up for a rough transition to NPI-only claims. That's the lesson to take away from a recent Medicare National Provider Identifier conference.

There is some good news, however, according to CMS: "We are proud to report that 99.87 of all Part A claims now have an NPI," said a federal official speaking at the Feb. 6 CMS-sponsored call.

But temper that with the news that some claims, particularly Part B, are still coming to contractors with no NPI. And CMS and others are saying that the most problematic stretch in the transition likely lies ahead.

"We're not hearing about a lot of problems yet, but we may just be too early in the process," says consultant Bobby Dusek of Abilene, Texas, echoing the concern of other experts contacted recently by Eli.

CMS officials speaking during the call cast the spotlight on the "enrollment challenges" that providers would need to address before moving smoothly to the next stage in the transition.

Deadlines: Starting March 1, "you will not be able to get paid for any Medicare services you provide until you begin using your NPI," CMS stressed in a recent e-mail message to providers. The other key deadline is May 23. By that date, you must be able to submit Medicare claims with only the NPI in the primary fields.

But there could be trouble ahead. Providers that have been asked to resubmit information on their 855 enrollment form should 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 Medicare contractor 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 the call.

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

Note: For more information on the new 855 enrollment form, see the next issue of Physical Medicine & Rehab Coding Alert.

Some providers submitting legacy number-only claims have yet to get a warning from their Medicare contractor that things are about to change. That could make it seem as though you have no NPI worries, but that's far from the truth.

"You should be receiving informational messages [from your intermediary] if you are submitting claims with the legacy number only," a CMS official said. "Ask your clearinghouse if you are not getting these [error] messages."

During the Q&A call, CMS also issued these warnings about common NPI mistakes.

• Make sure your numbers agree. "We are still receiving claims with a group NPI and an individual legacy number at the primary provider level," the agency said. "This is not a valid combination, and it will reject."

• Make sure the information in the National Plan and Provider Enumeration System (NPPES) matches the information on your enrollment form.

• If you are a DME supplier and a sole proprietor, make sure you obtained your NPI properly and that you reported your legacy ID to NPPES in the correct field, CMS said during the call. If you have a Social Security number in NPPES and an Employer Identification Number on file with the National Supplier Clearinghouse, your NPI/legacy numbers will not match and your claims won't pay, the official said.

Best advice: "Pay attention to information from Medicare contractors and CMS," one agency official said during the call.

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