Industry Notes:
NPI-Only Requirement Brings Claims System Headaches
Published on Tue May 27, 2008
Ability to view and fix claims is on the fritz after NPI deadline.
Providers hoping for a smooth Medicare claims processing transition, for once, were disappointed May 23.
That's the date that Medicare began requiring providers to submit claims and other HIPAA-compliant transactions with a National Provider Identifier number only--no Medicare legacy numbers, such as OSCAR numbers.
Problem: "Due to the installation of the NPI-only requirement for May 23, 2008, we are experiencing a problem with providers viewing and updating the RTP file and doing adjustments to previously paid claims," reports regional home health intermediary Cahaba GBA in a message to providers.
More problems: RHHI Palmetto GBA is seeing similar disruptions. "Providers are unable to view claims in the Corrections and Summary Menu," Palmetto says on its Web site. Also, "providers are unable to key their PTAN and NPI numbers in Direct Data Entry (DDE) System."
The Centers for Medicare & Medicaid Services' claims system contractor knows of the problems and is working on them, both RHHIs assure.
Solution: For Palmetto's DDE entry problem, providers can use their mouse to get the cursor into the NPI field, the RHHI advises. Then providers should be sure not to enter legacy numbers.
Providers might be experiencing more customer service hassles due to the NPI as well. Thanks to NPI rules, Cahaba must "authenticate certain provider identification elements for telephone inquiries," the intermediary tells providers in a recent message.
Providers must enter their NPIs and legacy numbers for customer service, Cahaba instructs. If one of those is invalid, the provider must provide two of the following: provider name, tax ID number, remittance address or master address.
"Please be prepared to provide this information when you call," Cahaba says. • Providers will be operating under revised claims appeals rules starting in August. CMS has finalized wide-ranging revisions to appeals in a May 23 Federal Register notice.
Among the changes is a requirement that providers must add any issues to an appeal within 60 days of the original 180-day period for appealing the claim payment.
Multiple commenters argued against this change, CMS notes in the rule. They said it restricts provider appeal rights, denies access to appeals and fails to give providers enough time to identify issues.
But CMS stuck by its guns. "For the efficient administration of the appeals process, we believe our policy of having the appeal resolved as early as possible, while at the same time giving the parties to the hearing ample opportunity to present their cases, is appropriate," the agency maintains. • Negotiations are heating up over the bill to halt physician's Medicare payment rate cuts that take effect July 1, and home care providers could end up getting burned. Senate Finance Committee Chair Max Baucus (D-MT) is moving ahead with a [...]
