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After numerous assurances that there would be absolutely no extensions, the Centers for Medicare and Medicaid Services has extended the May 23 deadline and is now giving physicians and other entities an extra year to obtain a National Provider Identifier number. My advice, however, is that you get yours as soon as possible to avoid any last-minute disruptions to your practice.
Medicare has been accepting the National Provider Identifier (NPI) since October, but as of next year, that is all they will accept; your so-called Medicare legacy identifier will be history.
The NPI came into being as part of the 1996 Health Insurance Portability and Accountability Act (HIPAA).
The idea was to provide a single, unique health identifier for each physician, health plan, and employer, eliminating all the various PINs, UPINs, and other unique and incompatible identifier numbers used by various plans (SKIN & ALLERGY NEWS, March 2007, p. 10). The ultimate goal is to more efficiently coordinate claims filing and payment, a welcome improvement for us all, should it work.
A popular rumor—that only physicians who participate in Medicare would need an NPI—is not true. All physicians will have to have the number, because the NPI will replace all other identification numbers issued by all third-party payers that fall under HIPAA's jurisdiction.
Some plans, classified as “small” (under 1 million subscribers) by HIPAA, already had an extra year to become NPI compliant, and that is sure to create some confusion. I suggest you communicate individually with each of your payers, regardless of size, to ensure you will have no problems.
One poorly understood aspect of the NPI transition is the “taxonomies,” or “specialty types,” which are associated with the NPI application process. (Most of the questions I'm receiving concern these.) Taxonomies are supplemental codes that categorize the scope of your office's clinical services.
Most dermatology offices will select the taxonomy code for general dermatology—207N00000X—but if your office provides specialized services, there are additional codes that may be required. These include:
▸ Dermatologic Surgery (207NS0135X)
▸ Dermatopathology (207ND0900X)
▸ Mohs Surgery (207ND0101X)
▸ Pediatric Dermatology (207NP0225X)
▸ Dermatologic Immunology (207NI0002X)
Select all of the additional codes that apply to your particular practice situation. Be aware that others may apply as well. There is a Web site devoted to outlining and explaining the taxonomy codes: http://codelists.wpc-edi.com/mambo_taxonomy_2.asp
When applying, be sure to include in your application as many of the numbers to be replaced as possible, such as your Medicare and Medicaid numbers and all identifiers used by various plans to which you belong.
Until the deadline, you are supposed to use both numbers—your NPI and the identifier you are using now—on all claims, so that there will be as little confusion as possible when the deadline passes.
Even if you already have your NPI, you must make sure you have made all the necessary changes to your practice to ensure a smooth transition. CMS lists seven steps:
1. Apply for an NPI at https://nppes.cms.hhs.gov/
2. Update your practice software, including billing applications, to incorporate your NPI.
3. Share your NPI with other providers, health plans, clearinghouses, and any other entity that may need it for billing purposes.
4. Communicate with all of your health plans and clearinghouses; make sure they are all as prepared for the NPI transition as you are.
5. Test your systems to make sure they can process claims and any other HIPAA-related transactions with the NPI.
6. Educate your staff thoroughly on the NPI transition.
7. Implement use of your NPI in all your business practices.
Most importantly, if you have electronic medical records and/or billing software, contact your software vendors as soon as possible to ensure that upgrades incorporating your NPI into all electronic transactions are available and will be installed prior to next year's deadline.
Alert vendors will have already provided these updates automatically, but don't count on that: Some vendors, especially those with relatively few medical clients, may be unprepared for, or even unaware of, the necessary changes. Or if your guarantee or software support contract has expired, you may have to remind the vendor to install the upgrades—and pay for them.
If your vendor is no longer in business, you will have to find an independent consultant to make the changes.
After numerous assurances that there would be absolutely no extensions, the Centers for Medicare and Medicaid Services has extended the May 23 deadline and is now giving physicians and other entities an extra year to obtain a National Provider Identifier number. My advice, however, is that you get yours as soon as possible to avoid any last-minute disruptions to your practice.
Medicare has been accepting the National Provider Identifier (NPI) since October, but as of next year, that is all they will accept; your so-called Medicare legacy identifier will be history.
The NPI came into being as part of the 1996 Health Insurance Portability and Accountability Act (HIPAA).
The idea was to provide a single, unique health identifier for each physician, health plan, and employer, eliminating all the various PINs, UPINs, and other unique and incompatible identifier numbers used by various plans (SKIN & ALLERGY NEWS, March 2007, p. 10). The ultimate goal is to more efficiently coordinate claims filing and payment, a welcome improvement for us all, should it work.
A popular rumor—that only physicians who participate in Medicare would need an NPI—is not true. All physicians will have to have the number, because the NPI will replace all other identification numbers issued by all third-party payers that fall under HIPAA's jurisdiction.
Some plans, classified as “small” (under 1 million subscribers) by HIPAA, already had an extra year to become NPI compliant, and that is sure to create some confusion. I suggest you communicate individually with each of your payers, regardless of size, to ensure you will have no problems.
One poorly understood aspect of the NPI transition is the “taxonomies,” or “specialty types,” which are associated with the NPI application process. (Most of the questions I'm receiving concern these.) Taxonomies are supplemental codes that categorize the scope of your office's clinical services.
Most dermatology offices will select the taxonomy code for general dermatology—207N00000X—but if your office provides specialized services, there are additional codes that may be required. These include:
▸ Dermatologic Surgery (207NS0135X)
▸ Dermatopathology (207ND0900X)
▸ Mohs Surgery (207ND0101X)
▸ Pediatric Dermatology (207NP0225X)
▸ Dermatologic Immunology (207NI0002X)
Select all of the additional codes that apply to your particular practice situation. Be aware that others may apply as well. There is a Web site devoted to outlining and explaining the taxonomy codes: http://codelists.wpc-edi.com/mambo_taxonomy_2.asp
When applying, be sure to include in your application as many of the numbers to be replaced as possible, such as your Medicare and Medicaid numbers and all identifiers used by various plans to which you belong.
Until the deadline, you are supposed to use both numbers—your NPI and the identifier you are using now—on all claims, so that there will be as little confusion as possible when the deadline passes.
Even if you already have your NPI, you must make sure you have made all the necessary changes to your practice to ensure a smooth transition. CMS lists seven steps:
1. Apply for an NPI at https://nppes.cms.hhs.gov/
2. Update your practice software, including billing applications, to incorporate your NPI.
3. Share your NPI with other providers, health plans, clearinghouses, and any other entity that may need it for billing purposes.
4. Communicate with all of your health plans and clearinghouses; make sure they are all as prepared for the NPI transition as you are.
5. Test your systems to make sure they can process claims and any other HIPAA-related transactions with the NPI.
6. Educate your staff thoroughly on the NPI transition.
7. Implement use of your NPI in all your business practices.
Most importantly, if you have electronic medical records and/or billing software, contact your software vendors as soon as possible to ensure that upgrades incorporating your NPI into all electronic transactions are available and will be installed prior to next year's deadline.
Alert vendors will have already provided these updates automatically, but don't count on that: Some vendors, especially those with relatively few medical clients, may be unprepared for, or even unaware of, the necessary changes. Or if your guarantee or software support contract has expired, you may have to remind the vendor to install the upgrades—and pay for them.
If your vendor is no longer in business, you will have to find an independent consultant to make the changes.
After numerous assurances that there would be absolutely no extensions, the Centers for Medicare and Medicaid Services has extended the May 23 deadline and is now giving physicians and other entities an extra year to obtain a National Provider Identifier number. My advice, however, is that you get yours as soon as possible to avoid any last-minute disruptions to your practice.
Medicare has been accepting the National Provider Identifier (NPI) since October, but as of next year, that is all they will accept; your so-called Medicare legacy identifier will be history.
The NPI came into being as part of the 1996 Health Insurance Portability and Accountability Act (HIPAA).
The idea was to provide a single, unique health identifier for each physician, health plan, and employer, eliminating all the various PINs, UPINs, and other unique and incompatible identifier numbers used by various plans (SKIN & ALLERGY NEWS, March 2007, p. 10). The ultimate goal is to more efficiently coordinate claims filing and payment, a welcome improvement for us all, should it work.
A popular rumor—that only physicians who participate in Medicare would need an NPI—is not true. All physicians will have to have the number, because the NPI will replace all other identification numbers issued by all third-party payers that fall under HIPAA's jurisdiction.
Some plans, classified as “small” (under 1 million subscribers) by HIPAA, already had an extra year to become NPI compliant, and that is sure to create some confusion. I suggest you communicate individually with each of your payers, regardless of size, to ensure you will have no problems.
One poorly understood aspect of the NPI transition is the “taxonomies,” or “specialty types,” which are associated with the NPI application process. (Most of the questions I'm receiving concern these.) Taxonomies are supplemental codes that categorize the scope of your office's clinical services.
Most dermatology offices will select the taxonomy code for general dermatology—207N00000X—but if your office provides specialized services, there are additional codes that may be required. These include:
▸ Dermatologic Surgery (207NS0135X)
▸ Dermatopathology (207ND0900X)
▸ Mohs Surgery (207ND0101X)
▸ Pediatric Dermatology (207NP0225X)
▸ Dermatologic Immunology (207NI0002X)
Select all of the additional codes that apply to your particular practice situation. Be aware that others may apply as well. There is a Web site devoted to outlining and explaining the taxonomy codes: http://codelists.wpc-edi.com/mambo_taxonomy_2.asp
When applying, be sure to include in your application as many of the numbers to be replaced as possible, such as your Medicare and Medicaid numbers and all identifiers used by various plans to which you belong.
Until the deadline, you are supposed to use both numbers—your NPI and the identifier you are using now—on all claims, so that there will be as little confusion as possible when the deadline passes.
Even if you already have your NPI, you must make sure you have made all the necessary changes to your practice to ensure a smooth transition. CMS lists seven steps:
1. Apply for an NPI at https://nppes.cms.hhs.gov/
2. Update your practice software, including billing applications, to incorporate your NPI.
3. Share your NPI with other providers, health plans, clearinghouses, and any other entity that may need it for billing purposes.
4. Communicate with all of your health plans and clearinghouses; make sure they are all as prepared for the NPI transition as you are.
5. Test your systems to make sure they can process claims and any other HIPAA-related transactions with the NPI.
6. Educate your staff thoroughly on the NPI transition.
7. Implement use of your NPI in all your business practices.
Most importantly, if you have electronic medical records and/or billing software, contact your software vendors as soon as possible to ensure that upgrades incorporating your NPI into all electronic transactions are available and will be installed prior to next year's deadline.
Alert vendors will have already provided these updates automatically, but don't count on that: Some vendors, especially those with relatively few medical clients, may be unprepared for, or even unaware of, the necessary changes. Or if your guarantee or software support contract has expired, you may have to remind the vendor to install the upgrades—and pay for them.
If your vendor is no longer in business, you will have to find an independent consultant to make the changes.