Medicare has mandated a change from the current provider identification system to a new National Provider Identifier (NPI). The change will occur on May 23, 2007. This change is not an option, but is mandated for Medicare and, ultimately, all private payers that accept electronic claims. This article tells you what you need to know now about the NPI. We also provide a brief overview of the Tax Relief and Health Care Act of 2006 and its impact on urologists.
Officially, Medicare should allow an office to include both the NPI and the current Physician Identification Number (PIN) until the change date. All payers are required to process claims with your older PIN until May 23. Many private-sector payers are not capable of accepting the NPI at this time, but some, such as Medicare, are capable of accepting the NPI with the older PIN.
You may be wondering why you should bother using the NPI at all if a PIN works. In our experience, dry runs can be useful in preventing many disasters. We would strongly recommend that you obtain and begin using your NPI in conjunction with your current PIN as soon as possible. The NPI will be your financial lifeline after May 23, as Medicare will no longer process claims without the NPI after that date.
Private-sector payers may establish timelines that are slightly different from those established for Medicare, but the larger payers will comply with this mandate (part of the Health Insurance Portability and Accountability Act).
Also, you will need to start collecting the NPIs of your referring providers, as these will be required for consults after the May 23 deadline as well. Medicare is supposed to put together crosswalks, and private payers have also been instructed to build PIN-to-NPI tables. These crosswalk tables are built to allow claims processing with either the PIN or NPI, as they will contain a match of the PIN to the NPI. Even with these tables or crosswalks, all physician offices understand the problems caused by missing referring provider numbers or the extra work that is required to obtain these numbers.
The transition period will not be easy. Ultimately, however, the NPI should make medical service providers less dependent on some vendors and better able to share critical patient data. The standardization to the provider-specific NPI mandated across all providers is designed to eliminate some of the custom numbers currently required by some private payers. With the elimination of custom numbers and some of the older PIN numbers in existence, the system will take one more step toward improving electronic communication.
To obtain your NPI, visit this link for an easy-to-use application process.
Conversion factor cut averted
As most physicians know by now, Congress has stepped in to block the conversion factor reduction for Medicare services. The Deficit Reduction Act of 2006 was signed by President Bush, and Medicare was able to make the fee schedule changes prior to Jan. 1, 2007, avoiding at least in part some of the problems created last year.
The Tax Relief and Health Care Act (TRHCA) of 2006 achieved several things, including:
It blocked the 5% reduction in the conversion factor for Medicare fees in 2007. The conversion factor was frozen at 2005 levels (37.8975).
The geographic practice cost index (GCPI) floor has been extended for 1 year. No area will have a work GCPI less than 1.000, thus preventing an additional decrease in payment for Medicare areas.
It established an incentive to participate in the provision of pay for performance information for 2007 and 2008. Particulars of this aspect of the program will be released by Medicare and are not expected to begin until July of this year.
The final impact of all the changes—including relative value unit changes and the freezing of the conversion factor—will translate into a 0% change in overall Medicare payments to urologists for 2007.
Unlike previous fixes to the Medicare fee schedule that will require an adjustment in future years, the TRHCA is a funded temporary fix to the fee schedule. The system will still require reductions in the fee schedule in future years of the program and, therefore, efforts must continue to focus on changing the basic formula used to update Medicare from year to year.
The TRHCA did not remove the budget neutrality adjustor, nor did it affect the changes to relative value changes planned for 2007, so you will want to review your proposed contracted fee
schedules carefully. Avoid budget neutrality adjustors and straight percentage of Medicare fee schedules, if possible.
Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver and is also publisher of Urology Coding and Reimbursement Sourcebook
Mark Painter is CEO of PRS Urology SC in Denver.
Disclaimer:
The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.
