Home Health & Hospice Week

Claims coming back? Tap these resources.

Small home medical equipment suppliers may be facing the roughest waters in the Medicare transition to National Provider Identifiers.

In a missive designed to clear up common misconceptions about NPIs, the Centers for Medicare & Medicaid Services noted recently that suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) are seeing an unusual number of claims bouncing back due to NPI-related problems.

"Medicare DMEPOS suppliers may be experiencing claims rejections if they did not obtain their NPIs properly, if they are not properly enrolled in Medicare, or both," said CMS in its clarification.

Tripping point: Suppliers that have "sole proprietorship" businesses are likely hitting the most snags.

Details: If you are a sole proprietorship en-rolled with the National Supplier Clearinghouse as an organization and furnished an Employer Identification Number (EIN) instead of a Social Security Number (SSN), but obtained an NPI as an "Entity type 1 - Individual," the Medicare NPI Crosswalk will be unable to link your Medicare legacy identifier (the NSC number) to your NPI.

"This is because the NSC number and the NPI identify different entity types--one identifies an organization and the other an individual," CMS explains. And if the legacy number and NPI can't link in the NPI crosswalk, your claim will reject.

Solution: For assistance in correcting the problem, call the NPI Enumerator assistance line at 1-800-465-3203, advises CMS. If you do not understand the error message you receive with a rejected claim, contact your DME Medicare Administrative Contractor.