Critical NPI Date Approaching for Medicare Billing
Beginning March 1, all Medicare claims must contain a National Provider Identifier (NPI) and legacy number, or just an NPI number, for billing, pay-to and rendering physicians. Legacy numbers can still be used to identify referring and ordering physicians through the end of the NPI contingency period, which is May 23.
Physicians who bill Medicare and are being paid for claims submitted with both an NPI and a legacy number are strongly urged to test their ability to get paid using just their NPI. To test this, they should submit one or two claims as soon as possible. This step is critical to ensuring that their claims will be processed without interruption beginning March 1.
If Medicare cannot match a physician’s NPI to his or her legacy number in its system, the claim with an NPI only will be rejected. If the claim is processed and the physician is paid, the physician can continue to increase the volume of claims sent with only the NPI. Physicians whose claims are rejected should call their Medicare carrier or the enrollment staff with their Medicare Administrative Contractor for Part A and Part B for advice right away.
Note: If Medicare cannot match a physician’s NPI to his or her legacy number, the physician might be required to re-enroll, a process that can take several months. Physicians are urged to act now to avoid claims processing problems on March 1.
After May 23, no legacy numbers will be permitted on any electronic claims, including those to Medicare and commercial payers, pursuant to the Health Insurance Portability and Accountability Act. In addition, no legacy numbers will be permitted on Medicare paper claims after this date.