Last month’s NPI article focused on the plan to get you through NPI migration while minimizing cash flow issues through the changes. Not all payers are through the transition yet, so it is important to keep focused on plans geared towards reducing cash flow risks.
Last month’s NPI article focused on the plan to get you through NPI migration while minimizing cash flow issues through the changes. Not all payers are through the transition yet, so it is important to keep focused on plans geared towards reducing cash flow risks.
When your cash flow is stabilized and the majority of your payers are migrated to accepting NPI as the only identifier for you, your business and the secondary entities that show up on a claim, it’s time to start planning how to maximize NPI and make it work for you. It is important that you do not take the measures below while your claims are at a high risk level.
So what exactly does “work for you” mean? In the Federal register announcement of the NPI final rule, CMS said:
“In order to administer its programs, a health plan assigns identification numbers to its providers of health care services and its suppliers. A health plan may be, among other things, a Federal program such as Medicare, a State Medicaid program, or a private health plan. The identifiers it assigns are frequently not standardized within a single health plan or across health plans, which results in the single health care provider having different identification numbers for each health plan, and often having multiple billing numbers issued within the same health plan. This complicates the health care provider’s claims submission processes and may result in the assignment of the same identification number to different health care providers by different health plans.”
The benefits include reduced costs and improvements in efficiencies, quality of care, fraud and abuse detection. When implemented correctly, there are benefits to your practice such as taking most of the complexities out of the identification process. In a recent review of Sage Software client claim rejections, over 50% of the rejections were attributable to identifying the provider, the business or one of the secondary providers. While there are many reasons for this complexity, the promise of NPI is that we can eliminate the complexity surrounding these identifiers.
How do you know if you have work to do?
- If your practice is structured like Figure 1 and you only have one Billing Provider NPI (type II), you should be in great shape with no additional work to perform. Just do not allow a payer to force you to change unless something in your business changes. If it does change, keep reading. You’ll want to insure your multiple Billing Provider NPIs work for you. If your practice is structured more like Figure 2—with multiple Billing Provider NPIs (type II):
- Do all your payers use the same logic when deciding which Billing Provider to report?
- If Yes, perfect. This is the ultimate goal. No additional work for you to perform.
- If No, take one payer at a time and work with them to get your credentials in line with your goal. This will help you minimize the risk of creating cash flow problems while you and the payer work through the issue.
- There is one other area you should be looking to validate. Some of our clients are reporting problems in the “NPI only” era with utilizing Social Security Numbers (SSN) to represent their billing provider. If you have no Tax ID, it may be correct to utilize a SSN.
- However, if you were using SSN for some payers and Tax ID for others, you should take one payer at a time and work with them to get standardized on the use of your Tax ID. Addressing one payer at a time helps you minimize the risk of creating cash flow problems while you and the payer work through the issue.
Figure 1
Figure 1 represents the way a large percentage of our clients have enumerated their NPIs. The practice only has 1 Billing provider NPI that references the business. While this is the cleanest scenario, not all practices will be able to, or even want to represent their business in this manner.
Figure 2
Figure 2 represents a common reason for multiple Billing Provider NPIs being enumerated. In this scenario the practice has 3 locations, and providers associated with one or multiple locations. Medicare forced this type of scenario for a large section of multi-location practices.
If you are currently getting paid even though you are not optimally using NPI, take a slow, measured approach at changing one payer at a time. The big pay-off for you and the simplification of your ID structures can wait while you protect your existing cash flow.
Finally, while this article focused on your practice and provider NPI numbers, it appears the largest rejection rates we are seeing across the board have to do with sending referring providers, or facilities, and not having NPI numbers added. In speaking with clients, this appears to be an issue more related to habits and old data. To avoid these rejections and delay in reimbursement, make sure your internal controls are setup to monitor this. It may be as simple as reviewing your billing reports and double checking that the referring source, or facility, is indeed tied to an NPI number in your system.
