Get with the program

August 11, 2006

It's time to apply for your NPI

It's time to apply for your NPI

It's been reported that only 20 percent of the physicians and hospitals that participate in Blue Cross and Blue Shield of North Carolina have applied for and received their National Provider Identifier (NPI). Now, North Carolina isn't so different from the rest of the country. So it's a good bet that most of you are napping on this one.

This is not the time to nap. If you don't have an NPI by next May 23 and you file your Medicare and Medicaid claims electronically, CMS won't accept them. Moreover, most health plans have to use NPIs by then, and they might cut you off if you don't have one. Even physicians who submit paper claims will need an NPI to refer or admit patients or order tests, notes Craig Schlusberg, director of methodology development for First Consulting Group. Without that number from a referring physician, he points out, specialists and other healthcare providers won't be able to bill for their own services.

So far, CMS says, it has received about 875,000 applications for NPIs from individuals and organizations. By next May, CMS expects to issue 2.3 million NPIs, which will replace current billing numbers for Medicare and private health plans. If you're applying to participate in Medicare, you'll need an NPI now; ditto if you're changing your enrollment information.

A solo physician can file only under his own NPI, but if a group practice files claims under a group ID number, the practice itself will also need an NPI.

Major software vendors will upgrade practice management systems to add an extra field for the NPI, says Schlusberg, but some smaller vendors might not. If you want to avoid getting in trouble next year, ask your vendor when it plans to upgrade your system. Also, after you get your NPI, give it to your plans, your hospitals, and any other providers you regularly communicate with. For more information on the NPI, go to http://www.cms.hhs.gov/apps/npi/01_overview.asp.