Optometry Coding & Billing Alert

Published on Tue Sep 18, 2007 PDF

Tap Into New Database for All of Your NPI Needs

A phone call isn't necessary to locate referral/consult number

Save yourself a phone call by going online for national provider identifier (NPI) information using a query-only database from CMS: the NPI Registry.

You can search the National Plan and Provider Enumeration System (NPPES) database (https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do) by query using information such as a provider's name or NPI number. You-ll get a list of all NPPES records that meet the criteria you enter in the query. Once you select the record or records you wish to view, the NPI Registry displays the available information for that record.

The database includes real-time NPPES information, according to Empire Medicare's Web site. That means you-ll have quick access to Freedom of Information Act (FOIA) disclosable data for newly enumerated providers, as well as updates and changes to enumerated providers- FOIA-disclosable data as soon as it's available in the NPPES system.

Obtain Omitted Info by Going Online

Getting NPIs for referring physicians has been very time-consuming, says Rebecca Marthaller, CMRS, owner of Lower Columbia Medical Billing in Longview, Wash. -I know of many billing offices that are looking forward to this database.-

-I think this a step forward that we need,- says Shannon Smith, CRTT, CPC, CMSCS, director of coding and reimbursement for DoctorsManagement in Knoxville, Tenn. -One of the biggest provider complaints regarding NPI has been that they have not been published thus far--meaning when you received a referral/consult in which the NPI number is needed for the claim form, you would have to obtain this information from the practice even if it meant an additional phone call. Before the UPIN, we were able to look up that information.-

Important: Not all of your providers- information in the database will be publicly available, said CMS- Jim Bossenmeyer during a recent open-door forum. Social Security numbers, dates of birth, countries of birth and other sensitive data won't be in the public database.

Verify Your Number or Risk Rejections

-Be sure your legacy numbers are on file at the NPPES Web site,- says David Gibson, OD, FAAO, practicing optometrist in Lubbock, Texas. Between Sept. 3 and Oct. 29, 2007, all Part B carriers and DME MACS will begin to turn on edits to validate the NPI/legacy pairs submitted on claims. If the pair is not found on the Medicare NPI crosswalk, the claim will reject. For details, see http://gatewayedi.cmail4.com/l/239352/1446str/www.gatewayedi.com.