Part B Insider (Multispecialty) Coding Alert

Published on Sat Jun 28, 2003 PDF

The Centers for Medicare & Medicaid Services' new provider enrollment regulation will inflict chaos and confusion on unsuspecting physicians, industry reps say.

CMS held its latest Open Door Forum for physicians on June 16, and almost all of the questions concerned its enrollment reg, proposed April 25. Physicians and their representatives complained that the scheme will overwhelm Medicare carriers and create unnecessary duplication.

The Health Insurance Portability and Accountability Act already imposes a national provider enrollment number on physicians as part of its transaction standards, said Jack Emery, Washington lobbyist for the American Medical Association. "Why is it we're going through this process?" he asked.

CMS officials countered that their plan takes into account the existence of HIPAA-mandated national provider identifier numbers. "We have designed a form to pick up the NPI when they are issued," said one CMS official. Another official pointed out that the NPI doesn't give physicians the privilege of billing Medicare.

But Emery saw the new Medicare mandate heralding a proliferation of provider numbers, especially if private health plans jump on the bandwagon and require their own different numbers. This "doesn't seem consistent with the purposes of HIPAA, which was to reduce the redundancy."

One CMS official held out the possibility that a physician who complied with its triannual enrollment procedures would be able to use a HIPAA-mandated NPI as a Medicare billing number as well.

Another participant in the teleconference asked how the carriers would handle the enrollment workload in the short time allowed.

CMS officials responded that they're looking at a few different scenarios, one of which is using regional contractors. CMS could hold a competitive bid to choose one private company that could have responsibility for three sectors of the country. This new contractor would then funnel information to existing carriers. CMS is eager to avoid ramping up the workload of existing carriers.

Medicare has had a "great experience" using the re-enrollment process for durable medical equipment suppliers already, CMS officials said. The new reg contemplates a number of enrollment forms, including the 855I for physicians renewing enrollment and the 855R for physicians who intend to assign payments to an entity such as a group practice.