CMS Promotes One-Day NPI Testing Exercise

CMS is promoting a one-day testing exercise, dubbed "Legacy Free Day," on May 7 that is aimed at helping Medicare providers evaluate their National Provider Identifier, or NPI, readiness before CMS' May 23 deadline for using the NPI number alone.

Currently, CMS is accepting claims with combo numbers -- both the provider's NPI number and legacy number -- to identify the provider. After the deadline, however, all electronic provider claims will be accepted only when the provider's NPI number alone is indicated in all provider identifier fields.

The Legacy Free Day will work like this: On May 7, participating clearinghouses will strip legacy identification numbers from Medicare claims that are submitted with combo numbers. The clearinghouses will send the claims to a provider's Medicare contractor with only the provider's NPI number.

If a provider's Medicare claims filed during the one-day trial are processed and paid by Medicare, the provider can assume that claims processing will flow smoothly after May 23. However, if Medicare claims are rejected or suspended, the provider should receive notification of that action within hours and will know that existing problems must be resolved before May 23.

Unresolved NPI problems could result in a backlog of unpaid Medicare claims and cash flow difficulties for physician practices.

According to AAFP coding specialist Cynthia Hughes, C.P.C., members who encounter difficulties with claims on May 7 may need to make simple corrections to information in their NPI enrollment data or to their Medicare enrollment. She said some providers might need to complete an updated Medicare enrollment form. More instructions on solving NPI problems are provided on the AAFP's Web site.

Hughes applauded CMS' efforts in organizing the NPI testing day because she said some physicians have already taken all the appropriate steps on their end. "This CMS initiative directly engages the claims clearinghouses," said Hughes. "This exercise could prove helpful to those physicians who are dependent upon their clearinghouse's readiness to test NPI-only claims," she added.