Some Clearinghouses Removing NPIs From Medicare Claims

Family physicians who are Medicare providers and use clearinghouses to process their claims need to know that some clearinghouses are stripping physicians' National Provider Identifier, or NPI, numbers from claims before submitting them to Medicare, says CMS.

In addition, says CMS, some clearinghouses have stripped the NPI out for Medicare processing only to add it back in on the physician's remittance advice.

CMS is urging physicians who use clearinghouses to contact those clearinghouses to ask them if Medicare claims are being sent through with NPI numbers intact.

"This situation is of great concern, because the day that Medicare pulls the plug and says that use of the NPI is mandatory, some of our members likely won't worry, thinking that they've been using their NPI number all along," says AAFP coding specialist Cynthia Hughes, C.P.C. "I don't know how a physician would know with certainty that a clearinghouse was stripping out his or her NPI numbers short of checking with Medicare on submitted claims."

Officials at CMS' regional office in Kansas City, Mo., say they are aware of the NPI stripping problem, but they have no comment as to why a clearinghouse would remove an NPI number only to add it back later.

Hughes speculates that some clearinghouses might be removing the NPI number because they may have neglected to update their systems to accommodate the nine-digit number on the Medicare claim form.

The NPI stripping scenario presents a headache for FPs participating in the voluntary Physician Quality Reporting Program, or PQRI, because Medicare claims must be submitted with the NPI number to qualify for PQRI and Medicare bonus money.

CMS is advising physicians to ask their clearinghouse directly about NPI stripping, and depending on the answer, is further advising physicians to change clearinghouses or to consider other billing options.

In addition, CMS has learned that some clearinghouses are not forwarding important messages from Medicare to physicians. This clearinghouse oversight also could hurt physicians financially, says Hughes. "Physicians need to know about any problems Medicare is having with their claims so the physician can fix the problem and reduce the likelihood of payment delays in the future," she says. Again, physicians must talk directly to their clearinghouses.

More detailed information about the clearinghouse problems is available in a recent "Special Edition" MedLearn Matters article. (10-page PDF; About PDFs). In addition, physicians can stay abreast of NPI issues by periodically checking the NPI portion of CMS' Web page.

CMS also has recently posted two new educational fact sheets on the NPI, one for organizational providers (2-page PDF; About PDFs) and one for providers who are sole proprietors (1-page PDF; About PDFs).