Part B Insider (Multispecialty) Coding Alert

Published on Mon Sep 15, 2014 PDF

Plus: AHA asks HHS to halt OIG audit practice of extrapolation.

You know just where to list your NPI on your Medicare claims, and you have your PTAN handy whenever you call your MAC about a billing issue. But do you know the difference between these two identifiers, and why they both exist? Many providers don’t—and CMS aims to clear that up in MLN Matters article SE1216, which the agency revised last week.

NPI: The National Provider Identifier (NPI) is distributed by CMS and is a unique 10-digit number that identifies your provider to the Medicare program. You’ll list the NPI on your claims and share it with other providers who need it to bill claims that you refer or order. If you’re part of a group practice, you’ll probably have one NPI for yourself and another for your actual organization.

PTAN: The Provider Transaction Access Number (PTAN) is a number that your MAC assigns you when you contract with it. You’ll use the PTAN to authenticate who you are if you contact your MAC with any questions (such as those about billing or payments). You typically won’t use the PTAN with CMS, but instead will use it with your local MAC.

Resource: For more on this issue, check out MLN Matters article SE1216 at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1216.pdf.