Hospitals and healthcare organizations assuming they still have until May 23 to transition to using the National Provider Identifier (NPI) on Medicare claims now have less time than they thought.
The Centers for Medicare & Medicaid Services has issued an email 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 said.
For now, 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 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. Jensen urges doctors to be prepared for the possibility of an earlier deadline, as well.
According to Jensen, co-chair 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," Jensen said. "The sooner they get NPI through the pipeline, the better."
CMS said it is 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 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 email says.
CMS advised providers that are currently using both NPI and legacy to be reimbursed should test a small sample of claims using only NPI.
"The test will serve to assure your claims will successfully process when only the NPI is mandated on all claims," CMS warned.