Just when doctors thought things couldn't get much worse, experts say, the Centers for Medicare & Medicaid Services has thrown another wrench into the already difficult transition to using National Provider Identifiers.
According to a June 11 CMS announcement, doctors will have to reconcile their NPI data with their IRS legal name data in order to get paid.
According to billing experts, this is a disaster waiting to happen. Every aspect of the data must match, including the exact spelling of names, the use of initials and even blank spaces in the data. The slightest discrepancy could send Medicare claims back to the drawing board.
After a year-long contingency period, the use of NPIs was required by CMS as of May 23. Both before and since that deadline, doctors have had difficulty getting paid due to a host of complications with CMS and clearinghouse systems, experts say.
Cyndee Weston, executive director of the American Medical Billing Association, said the IRS matching requirement "has blindsided the whole industry."
Weston, who works with small billing companies that submit claims for doctors, said many doctors who began using their NPI identifiers before the deadline have still not received Medicare reimbursements.
"This is going to affect all the doctors we work for. It's going to kill their practices," Weston said. "I think we haven't seen the worst of this yet. I think we're going to see a big uprising if this continues. No way around it."
Martin Jensen, chief operating officer and chief analyst at the Healthcare IT Transition Group, a consulting group specializing in helping doctors get paid, said physicians aren't getting consistent answers from the CMS or its intermediaries as to what's blocking the claims. The added stress of matching NPI to IRS data is going to compound their troubles.
"This IRS thing is very immediate and one we didn't anticipate," Jensen said. "It's definitely going to set off a cascade of mismatches to data."
The answer most physicians are getting from CMS is to start over with a new NPI enrollment. This could take months, Jensen said. Even doctors who have successfully had their claims paid under NPI could be forced to start over if their IRS data doesn't match, he added.
Are you a provider experiencing difficulty getting paid under NPI? Share your experiences with Senior Editor Diana Manos at Diana.manos@medtechpublishing.com.