Are You NPI Ready?

NPI – Get Ready by May 23

The Centers for Medicare and Medicaid Services announced that Medicare is receiving more than 98% of claims with an NPI. May 23, 2008, is the next milestone and requires providers to take the next step so they do not risk disruption in cash flow. Providers should begin billing with the NPI-only now, to test how May 23 will impact them. (Important Note:  if your audiologist does not yet have an NPI & Medicare enrollment, please continue to bill as you have in the past. Audiologists have until October 1, 2008 to obtain an NPI and enroll in Medicare.)

Clearinghouses need to get ready, too!

May 7 is  "Legacy Free" Day — an opportunity to check your practice's readiness to use its NPIs.

CMS has also asked clearinghouses that submit claims for fee-for-service Medicare plans to participate in a one-day NPI preparation exercise. On May 7, participating clearinghouses will send Medicare claims with NPIs in provider fields that originally contained NPI/legacy ID number pairs from the provider. In other words, clearinghouses will strip out the legacy identifiers when they are submitted as part of an NPI/legacy pair. Of course, claims already containing only NPIs will be sent to Medicare, along with claims showing only legacy numbers in secondary-provider identifier fields.

Steps to Facilitate a Smooth Transition to NPI Only

Step 1 – Bill with the Medicare legacy ID number and NPI. Once claims are successfully processed, move to Step 2.

Step 2 – Bill with the NPI only. Start with a small batch of claims. When the results are positive, begin sending a greater volume and move to Step 3. Billing with the NPI only also tests the ability to receive the NPI on 835 Remittance Advice (RA) transactions.

Step 3 – Test the NPI only on other Health Insurance Portability and Accountability Act (HIPAA) transactions. CMS will require the use of an NPI on 270/271, 276/277 and National Council for Prescription Drug Programs (NCPDP) transactions. Providers should begin testing the use of the NPI on these transactions, in small quantities, prior to May 23 to ensure a smooth transition. Also, providers should be prepared to accept the NPI only on the 835 RA (remittance advice) transactions.