NPI changes are just around the corner

As many of you are aware, May 23, 2008 is an important deadline for National Provider Identifier (NPI). That is the date when healthcare providers will be required to provide only their NPIs on all Medicare paper and electronic claims for reimbursement and it is expected that most carriers to follow Medicare’s lead. Find out what you need to do to prepare.

Today
- Know your payers and have contact information handy.
Make sure you know the value of each of these payers to your practice so you can focus on your highest impact payers first.

- Know your expected results.
You should be in sync with your payer on your Billing Provider NPI(s). For clarification, you should have one NPI for each of your providers (type I), and one or more NPIs that represent your business (type II). If you have only one that represents your business, your expectation would be that your payer is looking for that Billing Provider NPI, and you expect them to send back that Billing Provider ID in your payments. If you have sub-parted your Billing Provider NPI, you should have a clear matrix on what payers will receive what NPI numbers. This is expected to continue to be one of the most volatile areas of miscommunication and trouble.

- Know your referring doctor NPI #’s
It is important to be gathering NPI #’s from every provider you have a referring relationship with. Make sure these are updated in your systems. These are also required on May 23rd. For additional information on the importance of referring doctor NPIs, refer to the article in CMS' MLN Matters newsletter.

- Now is also the time to deal with any outstanding rejections or warnings.
Warnings are there to alert you to possible problems on May 23rd. Please make sure you understand why you are receiving the warnings. Many Sage Software clients are currently receiving warnings, but these may be because of our plan to have our clearinghouse partner submit both legacy and NPI identifiers until the payer commits to receiving NPI only.

Please refer to our NPI Checklist, which has proven very helpful to our clients in guiding them through the phases that payers may use to complete their NPI transition. The document includes important phone numbers, website information, a glossary of key NPI-related terms as well as a checklist to identify and easily address common reasons for NPI warning messages or rejections

May 23rd & the following 30-45 days
- Watch
Claims sent after May 23rd may quickly reject, may not reject but not get paid, or may disappear from view. All systems change during that time, and while the industry has spent over 2 years planning and testing, we will have our final live test during that time. So know exactly how many claims you sent and know where they are in the payment process. When something looks lost, don’t wait, start tracking them down immediately.

- Manage
Typically it takes a couple of weeks, or maybe even a month for some of your payers before you can expect payments. If you believe the reports all indicate the claims are at the payer and have not been rejected, have a plan to test that assumption by spot checking the status of some claims after a week. If something doesn’t look right, don’t wait for the payment, start tracking down the issue immediately.

- Keep Managing
Historically, system changes come in waves. Just because your initial wave of claims get paid correctly, you are not clear of risk. Other practices may have notified a payer of an issue and the payer may make changes to adjust, but that may put your next batch of claims at risk. It will be several months before you can feel like the majority of changes are implemented. That is when you can go back into normal claim management mode.

CMS resources
The Centers for Medicare & Medicaid Services (CMS) are hosting conference call sessions to help you navigate your way through these upcoming changes. These sessions are intended to address questions from the Medicare provider community prior to the May 23, 2008 NPI implementation deadline.

National NPI Roundtable
Date: May 14, 2008
Time: 2:00 to 3:30 PM EDT
Description: Providers are able to submit questions using the online registration system. In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data.
Register: National NPI Roundtable

National NPI Roundtable Q&A Session
Date: May 19, 2008
Time: 2:00 to 3:30 PM EDT
Description: Questions will be taken live during the presentation after a brief introduction. In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data.
Register: NPI Roundtable Q&A

For more information about upcoming changes surrounding NPI, visit the NPI section of the CMS website.