Medicare Compliance & Reimbursement

ENROLLMENT:

You'll Have A Physician NPI Directory At Last

HHS to make info available on the Internet.

You finally have a date that you can expect a National Provider Identifier (NPI) directory for referring physicians' NPIs.

The Centers for Medicare & Medicaid Services (CMS) will issue the NPI information June 28 as drawn from National Plan and Provider Enumeration System (NPPES) data.

"Anyone may request NPIs and other NPPES health care provider data from [the Department of Health and Human Services]," HHS says in a May 30 Federal Register notice. "HHS will make NPPES health care provider data available on the Internet."

HHS won't release sensitive information such as physicians' social security numbers, tax numbers and dates of birth. But other NPPES data will be in the directory. "We believe that making these data available on the Internet is the most efficient and effective means of dissemination," HHS says.

Resource: Find information at www.cms.hhs.gov/NationalProvIdentStand.

Compliance risk: If you don't have your NPI now that the May 23 deadline has passed, you are courting trouble. "At this point, any covered entity that is noncompliant, and has not implemented a contingency plan, is at risk for enforcement action," CMS warns in a message to providers.

CMS' contingency plan guidance "does not mean that providers have an extra year to get an NPI," CMS cautions. Under CMS' plan, providers should be using their own NPIs but can still use the previous "legacy" billing numbers for referring physicians. Try this: "Medicare is now asking that submitters send a small number of claims using only the NPI," CMS instructs providers. "If no claims are rejected, the submitter can gradually increase the volume."
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