American College of Physicians: Internal Medicine — Doctors for Adults ®

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Countdown is on to get National Provider Identifier

From the January-February ACP Observer, copyright 2007 by the American College of Physicians.

By Jessica Berthold

When William Rogers, MD, applied online for his National Provider Identifier (NPI)—the new number physicians are to use with all payers by late May—he was baffled to get an email back saying he'd been rejected.

"I thought, 'Oh boy, here we go. Now we're going to see the system fail'," Dr. Rogers recalled.

It was especially dismaying given that Dr. Rogers is the head of the Physicians Regulatory Issues Team for the CMS—the agency which is requiring all covered providers to have NPIs for electronic transactions by May 23, 2007.

Puzzled, he called the toll-free NPI helpline and was immediately connected to a woman who told him that, in fact, he already had been given an NPI.

"It turns out, the hospital I work for had already applied," said Dr. Rogers, who practices emergency medicine at Sibley Memorial Hospital in Washington, D.C. Dr. Rogers, who spends a lot of time traveling and talking to physicians, says he hasn't heard of doctors having a more serious problem than this when applying for an NPI.

William W. Reed, FACP, a rheumatologist in Norfolk, Va., said applying for his NPI was simple, but he ran into problems dealing with his billing software company.

"They told me the software I have is an older version and it isn't capable of handling the NPI," said Dr. Reed. "I'll have to pay $4,500 up front for the newer version."

CMS hasn't heard similar complaints, but still advises applying early to identify snags, a spokeswoman said. Some software provider contracts have clauses that require updates to be provided for free if they are needed to comply with federal regulatory requirements like the NPI, she added.

Test drive the NPI

The NPI, which is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), is meant to simplify standard health care transactions by giving each provider only one unique identifier (the NPI) to use with all health plans with which they transact. The number never changes, except in unusual circumstances, like fraudulent use.

As of early November, more than 1.4 million providers had gotten their 10-digit NPI, CMS reported. There are about 2.3 million covered providers in all. Medicare is already accepting NPIs, when submitted with legacy numbers, for claims transactions. Providers should check with private health plans individually as to whether they are ready to accept NPIs.

CMS said covered providers should apply for NPIs early so they can test drive them in advance of May 23, when billing for services without an NPI will be rejected. Waiting too long could cause payment delays or denials. Small health plans (under $5 million in annual revenue) have until May 23, 2008 to apply.

Physicians can either apply online, mail a paper application, or have an Electronic File Interchange Organization (an EFIO) handle their application if an EFIO has offered them this service. The online application, recommended by CMS as the fastest method, is here. The estimated time to complete the form online is 20 minutes.

Quick tips ease application

Here are some tips for applying for and using your NPI:

  • Physicians, mid-level providers, group practices, hospitals and other entities covered by HIPAA must apply.

  • Your NPI notification is sent to whoever is named as the Contact Person on your application.

  • If you apply online, keep a copy of your NPI notification email for your records, as well as the login/password you created on the Web.

  • If an employer has applied on your behalf, get a copy of the NPI notification letter containing your NPI for your records.

  • CMS advised including legacy identifiers, not only for Medicare but for all payers, when applying. If reporting a Medicaid number, include the associated state name.

  • Be sure you train staff on any changes to business practices that come from using the NPI, such as when to disseminate the NPI and when to collect it from other providers.

  • Identify who will need your NPI, such as health plans and clearinghouses, other providers and billing services. Confirm they are ready to receive it before sending it.

  • If there is enough time, and if your health plans support the "dual use" strategy, send electronic transactions with your NPI as well as your health-plan specific identifier as a transitional step. By May 23 you must use only the NPI, however.

For questions about your application, call the NPI Enumerator at 1-800-465-3203. For more NPI information, go here. A toolkit to help you apply for and use your NPI is available on the College's Web site.

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