Time to Get Your NPI

In May, CMS introduced a new Medicare Provider Enrollment Application form (CMS 855). This revised enrollment process makes it even more crucial to apply for your new National Provider Identifier number sooner rather than later.

Home medical equipment providers making changes to their enrollment must include their new NPI number on the form. You also must include a copy of the National Plan and Provider Enumeration System NPI notification with the application. Not only will no initial application be approved without this information, but you will not be able to update existing information without your new NPI.

If you receive your three-year re-enrollment in the mail, and you do not yet have your NPI number, you will not be able to submit the re-enrollment application until you get it. Since this process takes some time, you run the risk of having your Medicare provider number deactivated if you wait too long to apply for an NPI.

If you have not experienced a deactivation of your Medicare provider number, I do not recommend going through it. We all know how difficult it can be to have your number reactivated.

NPI numbers are not mandatory until May 23, 2007, but CMS recommends that you obtain your NPI at least six months prior to this date. You need to share it with any payers that may need it and also make sure there are no issues with the new number. You do not want to find out it does not work on May 24, 2007.

There are several ways in which you can apply for your NPI number. You can complete the online application at the NPPES Web site at https://nppes.cms.hhs.gov/NPPES/Welcome.do. If you prefer paper, go to www.cms.hhs.gov/apps/npi/01_overview.asp and download the application, fill it out and mail it using certified mail with a return receipt request.

Another way to apply is to authorize an employer or other trusted organization to obtain an NPI for you through bulk enumeration or Electronic File Interchange.

Regardless of how you obtain your NPI, it is important to retain a copy of the notification document that NPPES sends along with your NPI number, just as you would with your Medicare provider number document or your federal tax ID Document.

Medicare states it cannot predict the exact amount of time it will take to process an NPI application, but estimates that it should take 10 days for a properly completed electronic application. If you have not received your NPI via e-mail within 15 days of applying, call CMS at 800/465-3203.

Another change to the 855 is that providers and suppliers are required to complete the Authorization Agreement for Electronic Funds Transfer (CMS 588) when enrolling. Existing providers who are not currently receiving payments via EFT must change their enrollment information to accept EFT.

CMS also has removed Section 9 (Electronic Claim Submission Information), Section 10 (Staffing Companies) and Section 11 (Surety Bonds) from the application. In addition, information regarding overpayments no longer must be submitted. Also, Section 17 has been redesigned, making it easier for providers to identify which documents must be submitted with the enrollment application.

There also have been some enhancements to the 855 form. The form is more “visually pleasing” with larger font, and includes clarified headings and simplified language. Thankfully, the cover page now includes instructions to help the applicant submit the correct form. It also supplies the mailing address and gives information on the documents that must be included with the enrollment application.

Another new section includes tips on how to avoid delays in the enrollment process.

Plan ahead, and as always, make sure to read your updates because there will be many more to come.

This month’s column was co-authored by Kevin R. Bunch of CareCentric Billing Solutions.