With NPI Deadlines Looming, CMS Urges Physicians to Test Medicare's System Now

CMS is ramping up its efforts to get physicians' attention regarding need-to-know information about National Provider Identifier, or NPI, deadlines. According to CMS, nearly 10 percent of physicians still are filing claims without an NPI number.

An informational update released by CMS on Jan. 29 highlights key dates and information that physicians participating in Medicare should keep in mind.

In short, said CMS, physicians will not get paid for providing any Medicare services after March 1 unless they use their NPI number appropriately.

CMS urged physicians who currently are having difficulties getting claims processed to call their contractors now to resolve any issues because the volume of calls is expected to go up as the March 1 deadline approaches. Such difficulties might indicate that data preventing an NPI/legacy number match on the NPI crosswalk need to be corrected -- a process that can take quite a while to complete.

An additional word of caution from CMS to physicians concerns the May 23 deadline after which all electronic Medicare transactions must be billed using only the physician's NPI number.

CMS strongly suggests that physicians take advantage of the next couple of months to test Medicare's system in advance of May 23rd. Physicians who are billing successfully with the NPI and the legacy numbers in the primary provider fields should begin submitting a small number of claims to their contractors with just the NPI number to see if the claims are paid.

According to CMS, if the Medicare NPI crosswalk has not been able to match a physician's NPI to his or her Medicare legacy number, then claims submitted with only the NPI number will be rejected.

AAFP coding specialist Cynthia Hughes, C.P.C., also had a word of caution to members -- mainly solo practice physicians -- whose practices are incorporated. According to Hughes, she's heard from some members that claims have been rejected because the NPI information doesn't match their carrier's crosswalk to the enrollment data.

Hughes said physicians in that situation need to fill out new Medicare enrollment paperwork to enroll their organization, and the enrollment paperwork can take from 30 days to six months to process. "If any field on the form is left incomplete, the paperwork is returned to the physician, which starts a whole new processing period," said Hughes. "Physicians need to take care of this now in order to send NPI-only claims after May 23."