Old physician ID numbers are still OK for now, Medicare says

Washington -- The government will allow physicians who are not yet able to use their National Provider Identifiers on Medicare claims to use their old ID numbers for part of the next 12 months, but officials could pull the plug on this extension at any time.

The Centers for Medicare & Medicaid Services last month decided to implement a contingency plan when federal officials determined that not enough physicians, hospitals and other Medicare participants would be able to start using their NPIs on claims by the May 23 deadline. The new identifier will replace any existing IDs that doctors have used to bill the federal government or private insurers electronically.

Medicare will accept fee-for-service claims with old identifiers until at least July 1. If in June CMS determines that not enough participants have their NPIs and are ready to use them, it will push that date back to Aug. 1. The agency will continue to make monthly assessments of NPI readiness to decide when to end the contingency period.

At any point in the next 12 months, CMS could inform doctors that the following month will be the last one in which they can bill the program using old ID numbers, known as "legacy" identifiers. If they try to use them after that time, doctors risk Medicare claims denial and a halt in reimbursements. Under no circumstances will Medicare extend its acceptance of old identifiers past May 23, 2008.

In another break for physicians, Medicare will continue to allow claims filers to submit legacy numbers for "secondary providers," such as referring physicians, for the full 12 months.

The American Medical Association and the Medical Group Management Assn. supported the extension and have urged CMS to take the entire year to allow physicians to transition to the new system. In many cases, physicians have obtained their NPIs but are still waiting for vendors to update their practice management software to accept the new numbers in place of UPINs or other identifiers.

Private insurers, which also will use the NPI on electronic transactions, will decide on their own whether to accept legacy numbers for part or all of the year. Like Medicare, private payers could decide to terminate their extensions at any point beyond May 23 after notifying the physicians who bill them.

The potential that physicians will need to adhere to multiple NPI policies from multiple payers already is proving burdensome.

"It seems like some plans want you to start using the NPI now, some want the UPIN, some want both, and some haven't decided what they want," said Roger E. Belson, MD, an internist in Henniker, N.H. "It is a real nightmare for doctors who have to figure out how to make their practice management software do three different things, which in most cases is not even possible."