Health Information Compliance Alert

Published on Thu Feb 21, 2008 PDF

No news might turn into really bad news -- soon.

Now's the time to sound a loud warning if your billing office is behind in moving toward NPI-only billing for Medicare, especially if you're still sending -- and being paid for -- claims that include only your Medicare legacy number.

No. 1 problem: Some other providers submitting legacy number-only claims have yet to get a warning from their intermediary 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," cautioned a CMS official speaking at the recent NPI-focused Q&A call on Feb. 6. "Ask your clearinghouse if you are not getting these [error] messages."

End of the ride: Starting March 1, providers will not be paid for any claim submitted without an NPI -- even if your intermediary has been letting claims sail through.

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," cautioned the agency. "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. Even if you haven't had any NPPES-related problems yet, you should still double-check your NPPES information. That's because NPPES will establish a "verification process" with the Internal Revenue Service to check providers' legal names and employee identification numbers (EINs) against its files, CMS says in a message to providers. And if your NPI on your claims isn't backed up by correct NPPES records, the system will deny them.

• If you are a DME supplier and a sole proprietor, make sure you obtained your NPI properly and that you reported you legacy ID to NPPES in correct field, reiterated CMS 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 stressed during the call

Resource: More information about NPIs, go to http://www.cms.hhs.gov/NationalProvIdentStand.