Flaw exposed in new Medicare ID system

Washington -- Thousands of physicians could see Medicare claims delays or rejections because of discrepancies between the program's new identification system and doctors' old ID numbers, said organizations representing physicians and practice managers.

The Centers for Medicare & Medicaid Services instructed carriers starting Sept. 4 to no longer accept claims from physicians whose new ID numbers could not be matched with their older "legacy" numbers in a "crosswalk" file designed to link the old and new IDs. Medicare is in the process of transitioning to a system in which all physicians who submit electronic claims to payers are identified by a national provider identifier, a 10-digit number that eventually will replace UPINs and all other identifiers.

Carriers have encouraged physicians to include both old and new numbers on claims to ease the transition to the new system, but mismatches between claims data and the crosswalk file are still possible.

Because delayed or rejected claims might mean reduced cash flow to practices, CMS should reverse the new policy until physicians and carriers can work out the discrepancies, the American Medical Association and the Medical Group Management Assn. wrote in a Sept. 11 letter to Acting CMS Administrator Kerry Weems.

"As CMS is acutely aware, the magnitude of moving from using proprietary identifiers to the NPI is a change that has proven to be complex and costly for physician practices," the organizations stated. In addition, the agency informed physicians of the newest policy change only shortly before it instructed carriers to begin rejecting mismatched claims.

Matching NPIs with legacy identifiers is a complex process that is all the more difficult when larger practices have multiple old and new IDs, the letter said. With so many numbers in the mix, the AMA and MGMA said, mismatches are bound to happen, and physicians should be given more time to rectify them before being penalized.

CMS has been instructing physicians to be on the lookout for information "edits" that carriers may have been marking on their Medicare claims over the summer. These warnings should have let doctors know that contractors were failing to match NPIs with older ID numbers and the personal information that went along with them. If the problem persisted, carriers should have informed physicians by telephone or mail.

The AMA and MGMA noted that some physician practices that will be required to have both individual and organizational NPIs under the new system may encounter special problems unless they also have multiple PINs from the old system that carriers can use to link their information. The organizations asked CMS to clarify whether practices will need to go so far as to re-enroll in Medicare to obtain the necessary identifiers.

Physicians, carriers and health plans have warned the federal government that switching to the NPI system will require more time and effort than it has budgeted.

Medicare relented on its original May 2007 deadline for the program and most health plans to move to an NPI-only claims system.

Payers may continue processing claims using legacy identifiers up until May 2008, though any of them could pull the plug on the old ID systems before then.