Medicare to require physicians to use new ID numbers on March 1

Washington -- Two more national provider identifier deadlines are fast approaching for physicians.

As of March 1, doctors who bill Medicare electronically must include their NPIs on all Medicare claims in addition to any older IDs they may have been using. For most of the past year, the program has been allowing physicians to use their older, "legacy" identifiers alone while they obtained new NPIs and made sure the personal information attached to all of the numbers was matching correctly.

After May 23, physicians will be required to use only NPIs on all electronic claims submitted to Medicare and all other health care payers. That means any information discrepancies must be ironed out before then. Although the deadlines don't apply to physicians who file only paper claims, those who send their claims to a clearinghouse that files electronically on their behalf must comply. (See correction)

Some doctors continue to complain that the transition to the new identification system has been a bureaucratic nightmare. The Centers for Medicare & Medicaid Services in September 2007 told carriers to start rejecting claims for which physicians' personal information did not match between their new IDs and their old numbers. That move caused many physicians problems that in some cases stopped Medicare payments, reported the AMA and the Medical Group Management Assn.

In the hope of preventing additional pay stoppages, the organizations, in a Nov. 7, 2007, letter to CMS Acting Administrator Kerry Weems, asked the agency to soften the March deadline.

CMS is not likely to change the date because it is a necessary step on the way to an NPI-only system, said an agency official. Although CMS takes the claims-rejection issue very seriously because of its potential effect on practices' cash flow, it will likely take a missed payment or two before some physicians realize that they need to use their NPIs or that they need to get their identification information in order, he said.

"If we waited until the last minute, that wake-up call could be too late," he said. "At least if they get that wake-up call early on in March, they could pull all the stops" to become compliant by the May deadline.

The agency is recommending that physicians who have been successfully using both NPIs and older IDs try filing a few smaller test claims right away using only their NPIs, to see whether the carrier rejects them. That way, if their information is mismatched, they will have enough time before May to sort out the problem.

The CMS official said that the vast majority of Medicare physician claims are being filed without incident but that about 10% of claims continue to lack an NPI. When the agency instructed Medicare carriers in September to begin rejecting claims with mismatched IDs, the resulting rejection rates were relatively low, he said.

Still, the effects on practices were not insignificant, the AMA and MGMA said. Although physicians and their carriers were able to sort out most of the problems quickly, some doctors had or continue to have payment problems, they said.

Payments dry up

Gregory P. Kwasny, MD, an ophthalmologist in Milwaukee, thought he was doing the right thing when he signed up for a national provider identifier in the summer of 2006, long before many physicians started scrambling to beat enrollment deadlines. But when he did so, he ran into a glitch in the system that would not surface until more than a year later.

Because he is a solo, incorporated physician, Dr. Kwasny applied for a corporate NPI for Medicare billing. But because he only received an individual provider identifier number when he first enrolled in the program, the information associated with the old individual PIN and the new corporate NPI did not match.

It was only after CMS instructed carriers to begin rejecting mismatched claims last September that he found out he needed to re-enroll in Medicare to receive a group PIN that could be successfully matched with the corporate NPI. By then, the Medicare checks already had stopped flowing, and it would be a month before Dr. Kwasny could get the spigot turned back on.

"It was scary for a solo person," he said. "Medicare is 60% of what I do."

Dr. Kwasny was able to start receiving payments again by using only legacy ID numbers on claims, as allowed by Medicare's interim plan for moving to the new system. But he still has not received the group PIN that he needs. He worries that the backlog of Medicare re-enrollments could push this process past the March 1 date on which he needs once more to be using his NPI on claims.

The need for more outreach, speed

If CMS is planning to make a full transition to the new ID system within a matter of months, it must be better about informing doctors what they still need to do to become compliant, the AMA and MGMA said.

The agency said it already has conducted a significant amount of outreach and will continue to work with physician organizations, carriers and other groups to get the word out to doctors. But, the physician organizations wrote in their letter to CMS, a "rapid and direct outreach plan" with a special focus on small practices and those in rural areas will be necessary for all physicians to get on the right track. Regular conference calls to state and specialty medical societies as well as more direct carrier outreach to doctors experiencing problems should be conducted, they said.

At the same time, carriers need to speed up Medicare re-enrollment for physicians who need to go through that process before their NPIs will work, the AMA and MGMA said. By making the application process less complicated, CMS could help address enrollment backlogs, which exceed 90 days for some carriers, they said. CMS says the strict application requirements are necessary to ensure appropriate payment.

The organizations also made another bid to get carriers to stop rejecting claims on which information mismatches occur. If the situation does not improve soon, CMS might even need to reconsider the May 23 deadline for using NPIs alone on all electronic claims, the letter stated.

But because all payers -- not just Medicare -- will require the NPI alone after that date, Medicare is not likely to push off its own compliance date, the CMS official said.