HCFA delays new provider ID, but assures proposal soon
Now you see it, now you don’t. That’s how many practice managers describe the National Provider Identifier (NPI) requirement a new ID number soon to be needed on all Medicare claims.
At one point, many practice managers were receiving notices from their carriers that the NPI would go into effect in January, while others were predicting July. Now HCFA officials are pushing the deadline further back, but they won’t be pinned down on exactly when.
The new ID numbers are important because they can be complex to apply for, and they will be required for payment at some point in the future, warns Wanda Ziemba, senior consultant for Rheinisch Consultants in San Ramon, CA. (See related story on NPIs in Physician’s Payment Update, May 1997, pp. 78-79.)
"In February I had a client whose Medicare claims were denied because they didn’t have the NPI number on them," Ziemba says. As it turns out, the number wasn’t required because the deadline had been postponed, even though the carrier’s software already was set up to kick out claims that lacked the number. If your claims are mysteriously kicked back without payment, that’s one feature you might want to check.
HCFA still has time to implement the NPI within the framework of the law, explained Richard Husk, acting director of HCFA’s Office of Program Requirements, in a recent letter to the Chicago-based American College of Surgeons.
The Health Insurance Portability Act of 1996 requires that within 18 months of enactment, HHS adopt standards for specified transactions and data elements to enable health information to be exchanged electronically, Husk says.
The proposed regulation recommending NPI as the standard for the industry and for Medicare transactions, originally scheduled to appear in a February issue of the Federal Register, has been delayed. "We anticipate that it will take at least five months to publish the final regulation after the proposal is published, and at least another five months to implement the NPI in Medicare operations," Husk said.
Once the regulation clears, however, NPIs will be a definite requirement that HCFA will not overlook, he says.
"All providers currently enrolled in the Medicare program will automatically receive their NPIs from the carrier or intermediary to which they submit claims," Husk says. But don’t expect it to be that easy, contends Ziemba.
"Physicians should be looking for a special application packet in the mail," she warns. When filing for other ID numbers, it can take four months to get them, and the actual form can be quite complex, she says.
The positive piece of the new requirement is that it should help alleviate payment delays when claims have two payers involved. "It should simplify Medigap/Medicare claims," she says. "Often there is a lot of confusion with Medigap claims. Whenever you have coordination of benefits, you often have a hang-up between one carrier or the other. This should make filing claims with secondary payers much easier."
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