Practice Manager Insider

Do You Have Your National Provider Identifier?

The National Provider Identifier (NPI) is a 10-digit, numeric identifier administered by the Centers for Medicare & Medicaid Services (CMS). Providers must obtain one in order to bill CMS as of May 23, 2007. This is because the Health Insurance Portability and Accountability Act of 1996 (HIPAA) required that the Department of Health and Human Services adopt a standard, unique number for healthcare providers, and the department chose the NPI. All HIPAA-covered providers must use an NPI to identify themselves in HIPAA standard transactions as of May 23, 2007. Large health plans and healthcare clearinghouses also must use only the NPI to identify covered providers in standard transactions as of that date. Small health plans have another year to convert to using only the NPI – until May 23, 2008.

    

The Lash Group recommends using obtaining and using an NPI along with appropriate legacy identification numbers before the NPI is required. One advantage of the NPI is that it replaces all legacy identification numbers. Practices no longer will have to keep track of different identifying numbers for each health plan and for CMS. The number also does not expire or change; it follows a provider who switches jobs or location.

    

CMS has established the following timeline for phasing in usage of the NPI:

Now through October 1, 2006:  Providers must use their existing legacy Medicare number on claims. Including an NPI is optional. CMS will reject claims bearing only an NPI.

October 2, 2006 through May 22, 2007: CMS will accept either the NPI or an existing legacy Medicare number on claims. CMS strongly recommends that providers include both numbers in case issues arise with the NPI during this time. If there is an issue with the provider’s NPI and no Medicare legacy identifier is submitted, the provider may not be paid for the claim.

May 23, 2007 onward: CMS will accept only claims with NPI numbers from all but small health plans.    

    

The CMS website contains information about how to apply for an NPI and about whether a provider with subparts needs multiple NPIs.

New at CMS: Software for Remittances, CAP Information Posted

The Center for Medicare & Medicaid Services (CMS) has posted on its website an article explaining its new Medicare Remit Easy Print software. Practices can use this software to view and print Electronic Remittance Advice (ERA) that complies with the Health Insurance Portability and Accountability Act (HIPAA). CMS had previously announced its plans to reduce the number of Standard Paper Remittance Advices (SPRs) printed and mailed, and to increase use of the electronic remittances (ERA). To use the easy print software, practices must receive HIPAA-compliant ERAs. Contact your carrier to find out more about how to obtain the software or how to receive HIPAA-compliant ERAs.

In other CMS news, the slides and audio from a May 11 teleconference about the Competitive Acquisition Program (CAP) for Medicare Part B drugs and biologicals are  posted on the CMS website. The teleconference program was called “Ask the Contractor.”