Part B Insider (Multispecialty) Coding Alert

Published on Tue Aug 07, 2007 PDF

Medicare will start rejecting claims with non-matching NPIs

It's crunch time: If Congress doesn't act in September to prevent the 9.9 percent cut that's scheduled for Jan. 1, there may not be another chance, warn Capitol Hill insiders.

The House and Senate both passed bills that would expand the State Children's Health Insurance Program (SCHIP), but only the House version also gets rid of the 15-percent pay cut you-re facing in 2008 and 2009. Top Senators are already indicating they want to rescue your Medicare pay later on, according to press accounts.

But -later- may never arrive.

-Given the press of business on both the House and Senate calendars for the remainder of the year, this is the best opportunity to address physician payment,- warned Kevin Burke, director of government relations for the American Academy of Family Physicians (AAFP) in a member bulletin. House leaders are convinced they won't have another opportunity to deal with Medicare issues this fiscal year, Burke added.

President Bush has promised to veto either SCHIP bill, but the Senate passed its version by a veto-proof majority, Burke noted. That majority might vanish if the bill included a Medicare pay fix.

Meanwhile, the House bill also would prevent doctors from sending patients to hospitals in which the doctors have a financial stake. And doctors couldn't receive any Medi-care payments for imaging services they conducted in their offices. Physician groups have spoken out against these provisions.

In other news:

- At last you can look up the National Provider Identifiers (NPIs) of doctors who send patients to your office. The lookup is available online at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do.

But meanwhile, the Centers for Medicare & Medicaid Services (NPI) said it would start rejecting Part B claims when your NPI and legacy numbers don't match information in a crosswalk. Until now, you-ve been receiving -informational edits- when your information didn't match. But starting Sept. 3, Medicare will just kick any non-matching claims to the curb.

- Your practice may be struggling, but doctors were in the top 20 occupations receiving salary increases in 2005, according to the Bureau of Labor Statistics. Doctors were in 12th place on that list in 1997, but in 2005 they rose to fourth place.

- If you joined the Competitive Acquisition Program (CAP) for Part B drugs and didn't receive a phone call from the CAP vendor, BioScrip, call your carrier to check on the status of your election, CMS advises.