NPI Numbers Required As Of May 23 for Reimbursement Are You Ready?
Roger S. Klotz, R.Ph., BCNSP, FASCP, FACA, FCPhA, CDM
I have been traveling to many home infusion providers and community pharmacies as a pharmacy surveyor for an accreditation organization. I have also been contacted and visited as a result of doing consultation to help organizations meet accreditation standards. I am very surprised that as we approach the closing days of January 207 that I am finding that a significant number of these organizations and their professional staff do not even know what NPI numbers are and when they become effective. The National Provider Identification (NPI) number becomes effective on May 23, 2007. At that time all other organizational and healthcare professional identification numbers will be replaced and the NPI number is required to submit claims and therefore obtain reimbursement.
The traditional pharmacy identification number developed and maintained by National Council for Prescription Drug Programs (NCPDP) numbers will no longer be accepted as pharmacy identifying numbers when submitting pharmacy claims for reimbursement, including Medicare Part D claims. The National Provider Identifier (NPI) will be the only identifier providers can use to be reimbursed for their services.
The physician identification known as the UPIN (Universal Physician Identification Number) will no longer be allowed on claims. The CMS has released the new form 1500 for paper and electronic claims which requires the use of the NPI number for all providers (healthcare professionals and organizations) to submit claims.
Failure to provide the new identifier will eliminate reimbursement for services. If the organization and its professional staff do not have their NPI number you only have only about three and half months to apply and receive your NPI number. You also have to train your staff on the full implications of the NPI number to the reimbursement process. Time is running out. It is important that you obtain an NPI number as soon as possible to avoid a reimbursement disaster.
Pharmacies with an NCPDP number should contact NCPDP to request an NPI number for their pharmacy. If you are a pharmacy owner, and applied directly for an NPI number, you should register your pharmacy’s NPI with NCPDP. Go to the NCPDP web site for instructions to register your pharmacy:
http://www.ncpdp.org
Individual pharmacists should also obtain an NPI, which should be used when billing for professional services, not when adjudicating pharmacy product claims. If your organization wants to bill for MTM and other cognitive services your pharmacists must have their own individual NPI. I received my NPI approximately a year ago so that I could provide MTM and Cognitive services as an individual practitioner.
The pharmacist and the organization can apply online now for their NPI to ensure that you are prepared in time by going to:
https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions
It is critical to all practitioners and their organizations that everyone takes the identification numbering system serious. A major factor and complication is that the payers will have to develop a cross walk between the old identification numbers to the new NPI. This will require time and effort on the payers’ side and therefore the sooner you get the payers your organization’s NPI number the more smoothly the transition will go for the organizations and its staff. If this does not occur before May 23, 2007 the organization will not be recognized as a provider by the payer when the change occurs and therefore cash flow will dry up. Congratulations to all of the organizations and healthcare professionals that have obtained their NPI numbers, since they will survive. It is critical to move on this issue immediately.