NPI Update and more

  • The Centers for Medicare and Medicaid Services (“CMS”) is ending its HIPAA National Provider Identifier (“NPI”) contingency plan effective May 23, 2008. Here are the looming deadlines for providers that submit electronic claims to Medicare. CMS is urging providers to test claims now.

March 3, 2008 – Medicare fee-for-service 837P and CMS-1500 claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim. You may not submit claims containing only a legacy identifier in the primary fields. Failure to submit an NPI in the primary fields will result in your claim being rejected or returned as unprocessable beginning March 1, 2008. Until further notice, you may continue to include legacy identifiers only for the secondary fields. May 23, 2008 –In keeping with the Contingency Guidance issued on April 3, 2007, CMS will lift its NPI contingency plan, meaning that only the NPI will be accepted on all HIPAA electronic transactions (837I, 837P, NCPDP, 276/277, 270/271 and 835), paper claims and SPR remittance advice. This also includes all secondary provider fields on the 837P and 837I. The reporting of legacy identifiers will result in the rejection of the transaction. CMS will also stop sending legacy identifiers on COB crossover claims at this time.

  • NCQA in cooperation with various medical associations has created standards that primary care medical practices can use to assess whether or not they function as a “patient centered medical home.” According to NCQA, “[t]he Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.” Heath plans are beginning to recognize medical homes in their provider directories.
  • The Leapfrog Group for Patient Safety has updated its compendium of pay for performance programs. Any organization may includes its P4P program in the compendium which is searchable for free.