Deadline changed for Medicare NPIs

WASHINGTON – Hospitals and healthcare organizations who think they have until May 23 to transition to the National Provider Identifier (NPI) on Medicare claims now have less time than they thought.

The Centers for Medicare & Medicaid Services has issued an e-mail calling for a new Jan. 1 deadline for hospital billing.

According to the e-mail issued via CMS list-serv, hospitals that fail to submit an NPI in the primary fields on Medicare fee-for-service institutional claims beginning Jan. 1 will have their claims returned as unprocessable, CMS officials said.

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The agency has not issued a similar new deadline for professional claims, such as those used by most doctors, clinics and labs, who are still expected to transition to NPI by May 23.

According to Martin Jensen, COO and chief analyst for the Healthcare IT Transition Group, this underscores that the NPI contingency announced by CMS regulators last spring was not a 12-month (compliance) delay, but rather a 12-month transition. He urges doctors to be prepared for the possibility of an earlier deadline as well.

According to Jensen, co-chairman of the Business Issues sub-workgroup of the Workgroup for Electronic Data Interchange, open-ended transitions cost the industry too much money and make it difficult for health care organizations to focus their experts on the next project.

“Right now, hospitals should be focusing on the present-on-admission data that needs to be added to Medicare claims,” he said. “The sooner they get NPI through the pipeline, the better.”

CMS officials have said they will be changing the required date to Jan. 1 because most providers have successfully made the transition and “the change to NPI has been in successful operation for all institutional provider claims since June 2007.”

The CMS notice goes on to say that providers may continue to submit NPI/legacy pairs but claims with only a legacy provider identifier for the primary fields will be returned as unprocessable. Further, legacy may still be used in secondary fields, the e-mail says.

CMS advised that providers currently using both NPI and legacy to be reimbursed should test a small sample of claims using only NPI.