Beginning May 23, 2008, all practicing physicians who treat Medicare patients must start billing with a working national provider identifier (NPI). Physician and non-physician providers can make any corrections or changes pertaining to their NPIs by contacting the National Plan and Provider Enumeration System (NPPES) at email@example.com, or by visiting the NPPES Web site, http://nppes.cms.hhs.gov.
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Explore This IssueMay 2008
The following changes should be implemented in rheumatology practices by May 23:
- Report the NPI in Box 17b on the CMS-1500 form (leave Box 17a blank);
- Leave blank the shaded portion of Box 24j (where providers are currently report the rendering provider’s PIN) of the CMS-1500 form; and
- Verify the NPI for all referring physicians when applicable.
There are steps that a rheumatology practice can take if a physician refers a new patient to the practice after May 23 but does not provide his or her NPI. First, the practice should call the referring physician’s office to obtain the NPI. If there is no response to the call, office staff can check the NPI database. In extreme circumstances, CMS gives instruction in Transmittal 235 of the Program Integrity Manual that the rendering provider can use his or her NPI in boxes 17 and 17b if they first take every step necessary to obtain the referring physician’s NPI.
Practices that find they cannot bill with their NPIs alone should contact their carriers or NPPES immediately.
For additional questions concerning this matter, contact Melesia Tillman, CCP, CPC, ACR’s practice management specialist, at (404) 633-3777, ext. 820, or firstname.lastname@example.org.