By now you have heard the acronym “NPI”. This stands for National Provider Identifier, and if you are a therapist billing services to Medicare and other carriers, you are required to have an NPI number. This major healthcare initiative is to establish unique identifiers for health care providers as the standard of identification in the industry. For reimbursement purposes, May 23, 2007 is the compliance date for utilization of the NPI number.

Are your systems ready? If you outsource your billing, you should check with your vendor to ensure they have upgraded their billing software to handle the new requirements. If you do your billing in-house, your billing software vendor should have already contacted you regarding an upgrade or update for the NPI necessities. If they have not done so, you should contact them immediately.

Once your software is updated, it is recommended you send a test file of claims to Medicare and/or your clearinghouse to ensure the proper information is placed in the proper order, to ensure your claims will be processed correctly on May 23rd and beyond. Be aware that even though your vendor has spent significant time testing the procedure, it often takes more than one test file to accurately set up the formats. If you are not familiar with this process, your billing software vendor support staff should be able to assist you.

Additionally, you will need to obtain the NPI number for each of your referring physicians. If you attempt to submit claims after May 22nd with legacy Medicare numbers for either your therapists or the referring physicians your claims may be denied.

If you have not received or applied for your NPI number, now is the time. You can apply online at https://nppes.cms.hhs.gov or call to request a paper application from the NPI enumerator at (800) 465-3203. It may take up to 90 days to implement the NPI into your business practice. Do not hesitate any longer.

There is an NPI contingency plan which permits Medicare and commercial insurers to continue accepting legacy provider identification numbers until May 23, 2008. To avoid payment disruption after the compliance date, providers should strive to enumerate their business and update practice management systems to accommodate both NPIs and legacy identifiers. To facilitate billing, practices should send their NPIs to all industry partners that require them.

If a complaint is filed against a covered entity for not implementing acceptance of the NPI by the deadline, CMS will evaluate the entity's "good faith efforts" to comply with the standards and would not impose penalties on covered entities that have deployed contingencies to ensure that the smooth flow of payment continues. Each covered entity will determine the specifics of its contingency plan. Contingency plans may not extend beyond May 23, 2008, but entities may elect to end their contingency plans sooner. Medicare will announce its own contingency plan shortly.

(Information has been provided by THE PROVIDER CONNECTION, a billing company dedicated exclusively to rehabilitation therapy providers. You can contact them at (888)952-4872 or www.theproviderconnection.com, and the AAPPO.)