Avoid Medicare Claims Rejections; Use Correct NPI

More physicians are using their National Provider Identifier, or NPI, numbers to submit Medicare claims, and CMS is continuing to alert physicians to glitches they may encounter in the process.

In a recent advisory, CMS reminded physicians to be mindful of the NPI number they use on Medicare claim forms. Specifically, the NPI number a physician uses to bill Medicare must match the physician's Medicare enrollment information.

If a physician is enrolled with Medicare only as an individual and mistakenly puts his or her corporation's NPI number on the form, Medicare will reject the claim.

Cynthia Hughes, C.P.C., AAFP's coding specialist, said CMS should continue to alert physicians to potholes that potentially could cause cash flow problems for practices, and physicians should be on the lookout for those updates.

"When your claims start rejecting is not the time to ask why they're being rejected," said Hughes.

She also voiced a more general reminder to physicians to not delay their entry into the NPI claims processing system. "If you're not yet sending claims with an NPI number, you need to begin doing so as soon as possible," she said. Hughes noted that the drop-dead date for converting to NPI usage is May 23, 2008, but added that CMS "has the authority to move that date up." She also pointed out that the current timeline is part of CMS' contingency plan that went into effect when it became clear that physicians could not meet the original NPI deadline.

"Once Medicare has its system in line, they'll expect everyone else to, as well," Hughes said.

The NPI, which was instituted as part of the Health Insurance Portability and Accountability Act of 1996, gives individual health care providers a unique identifying number. The 10-digit, numeric identifier does not expire or change and is administered by CMS.

Physicians should take advantage of regular CMS updates about the NPI and other Medicare-related issues by signing up to receive information via CMS' e-mail mailing lists. Although the agency currently is updating its mailing list service, physicians can bookmark the e-mail list sign-up Web page and check back later to set up their subscriptions.

Hughes recommends that family physicians subscribe to two specific mailing lists cited on the Web page -- "MLNMATTERS-L" and "PHYSICIANS-L" -- to receive the information most pertinent to FPs in private practice. Physicians can opt out of receiving other CMS e-mails they don't want by unsubscribing at the same page.