NPI Compliance

3/1/2007 9:38:21 AM
Medicare Part A and Part B

National Provider Identifier – 90 Days Until Compliance Date

There are less than 90 days left between today and the NPI compliance date of May 23, 2007. It is estimated that it may take at least this much time to implement the NPI into your business practices. Failure to prepare could result in a disruption in cash flow. Will you be ready to use your NPI? Time is running out!

Updating National Plan and Provider Enumeration System (NPPES) Information

All health care providers, including Medicare
providers, should include their legacy identifiers, as well as associated provider identifier type(s), on their NPI applications. If a provider has already completed an application and did not submit a legacy identifier, this provider should go back and update its information in NPPES. A provider can easily do so by using the web (https://nppes.cms.hhs.gov/). While doing so, providers should also validate other data in NPPES, such as address, contact person information, etc. and update anything that has changed.

Sharing NPIs

Once providers have received their NPIs, they should share their NPIs with other providers with whom they do business, and with health plans that request their NPIs. In fact, as outlined in current regulation, providers must share their NPI with any entity that may need it for billing purposes -- including those who need it for designation of ordering or referring physician. Providers should also consider letting health plans, or institutions for whom they work, share their NPIs for them.

New Frequently Asked Questions (FAQs) Posted
CMS has posted new NPI FAQs on its website. Questions include:
• For Medicare provider enrollment purposes, will group practices need to submit new CMS-855R’s for every member of the group practice in order to let Medicare know their NPIs?
• Will health plans link the National Provider Identifiers (NPIs) of group practices to the NPIs of the health care providers who are members of the group practices?
• Who needs an NPI – who is not eligible to apply for an NPI - what if I have a Drug Enforcement Administration (DEA) number – what if I only bill on paper – what if I do not submit claims to Medicare?
• Can my office Employer Identification Number (EIN) be used instead of a National Provider Identifier (NPI)?
• When do I need to use my National Provider Identifier (NPI)?
• Is a corporation that owns pharmacies that have National Provider Identifiers (NPIs) required to have an NPI in order to receive payments on behalf of the owned pharmacies?

To view these FAQs, please go to the CMS dedicated NPI webpage at www.cms.hhs.gov/NationalProvIdentStand and click on Educational Resources. Scroll down to the section that says “Related Links Inside CMS” and click on Frequently Asked Questions. To find the latest FAQs, click on the arrows next to “Date Updated”.

Upcoming WEDI Events

WEDI has several NPI events scheduled in the upcoming month. Visit http://www.wedi.org/npioi/index.shtml to learn more about these events. Please note that there is a charge to participate in WEDI events.
Important Information for Medicare Providers

Sharing NPIs with Medicare

In addition to updating critical data and legacy identifiers in the NPPES, Medicare providers should include both their NPIs and their Medicare legacy numbers in their Medicare claims. This will help Medicare build its NPI crosswalk by enabling Medicare to link provider’s NPIs to their Medicare legacy identifiers. Also, when Medicare providers make changes to their Medicare enrollment information, they are now required to furnish their NPIs when making those changes. Providers applying for Medicare enrollment must furnish their NPIs on their enrollment applications. These actions inform Medicare of provider’s NPIs.
There are no additional actions that Medicare providers need to take to inform Medicare of their NPIs.

Still Confused?

Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found at the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.

Getting an NPI is free - not having one can be costly.

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