TIP OF THE WEEK
NPI: Get it. Share it. Use it.
There are less than 90 days until the National Provider Identifiers (NPI) compliance date of May 23, 2007. It is estimated that it may take at least this much time to implement the NPI into your business practices. Failure to prepare could result in a disruption in cash flow. Will you be ready to use your NPI? Time is running out!
Updating National Plan and Provider Enumeration System (NPPES) Information
All health care providers, including Medicare providers, should include their legacy identifiers as well as associated provider identifier type(s) on their NPI applications. If a provider has already completed an application and did not submit a legacy identifier, this provider should go back and update its information in NPPES on the Web site at https://nppes.cms.hhs.gov. While doing so, providers should also validate other data in NPPES, such as address, contact person information, etc. and update anything that has changed.
Sharing NPIs
Once providers have received their NPIs, they should share their NPIs with other providers with whom they do business, and with health plans that request their NPIs. In fact, as outlined in current regulation, providers must share their NPI with any entity that may need it for billing purposes -- including those who need it for designation of ordering or referring physician. Providers should also consider letting health plans, or institutions for whom they work, share their NPIs for them.
New frequently asked questions (FAQs) posted
CMS has posted new NPI FAQs on its Web site. Questions include:
- For Medicare provider enrollment purposes, will group practices need to submit new CMS-855Rs for every member of the group practice in order to let Medicare know their NPIs?
- Will health plans link the NPIs of group practices to the NPIs of the health care providers who are members of the group practices?
- Who needs an NPI? Who is not eligible to apply for an NPI? What if I have a Drug Enforcement Administration (DEA) number? What if I only bill on paper? What if I do not submit claims to Medicare?
- Can my office Employer Identification Number (EIN) be used instead of a National Provider Identifier (NPI)?
- When do I need to use my National Provider Identifier (NPI)?
- Is a corporation that owns pharmacies that have National Provider Identifiers (NPIs) required to have an NPI in order to receive payments on behalf of the owned pharmacies?
To view these FAQs, please go to the CMS dedicated NPI Web site and click on Educational Resources. Scroll down to the section that says “Related Links Inside CMS” and click on Frequently Asked Questions. To find the latest FAQs, click on the arrows next to “Date Updated.”
Upcoming WEDI Events
Workgroup for Electronic Data Interchange (WEDI) has several NPI events scheduled in the upcoming month. Visit http://www.wedi.org/npioi/index.shtml to learn more about these events. Please note that there is a charge to participate in WEDI events.
Sharing NPIs with Medicare
In addition to updating critical data and legacy identifiers in the NPPES, Medicare providers should include both their NPIs and their Medicare legacy numbers in their Medicare claims. This will help Medicare build its NPI crosswalk by enabling Medicare to link providers’ NPIs to their Medicare legacy identifiers. Also, when Medicare providers make changes to their Medicare enrollment information, they are now required to furnish their NPIs when making those changes. Providers applying for Medicare enrollment must furnish their NPIs on their enrollment applications. These actions inform Medicare of providers’ NPIs. There are no additional actions that Medicare providers need to take to inform Medicare of their NPIs.
Still Confused?
Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found at the CMS NPI page on the CMS Web site. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.
Getting an NPI is free -- not having one can be costly!
March is National Nutrition Month
About 8.6 million Americans at least 60 years or older are diagnosed with diabetes or acute renal failure. Medical nutritional therapy (MNT) provided by a registered dietitian or nutrition professional may result in improved diabetes and renal disease management and other health outcomes and may help delay disease progression.
Medicare Coverage
Medicare provides coverage of MNT for beneficiaries diagnosed with diabetes or renal disease (except for those receiving dialysis) when provided by a registered dietitian or nutrition professional who meets the provider qualifications requirement, or a "grandfathered" dietitian or nutritionist who was licensed or certified as of December 21, 2000. A referral by the beneficiary's treating physician indicating a diagnosis of diabetes or renal disease is required. Medicare provides coverage for 3 hours of MNT in the first year and 2 hours in subsequent years.
What Can You Do?
As a trusted source of health care information, your patients rely on their physician's or other health care professional's recommendations. The Centers for Medicare & Medicaid Services (CMS) requests your help to ensure that all eligible people with Medicare take full advantage of the medical nutrition therapy benefit. Talk with your eligible Medicare patients about the benefits of managing diabetes and renal disease through MNT and encourage them to make an appointment with a registered dietitian or nutrition professional qualified to provide MNT services covered by Medicare.
For More Information
- For more information about Medicare's coverage of MNT services, visit the CMS Web site.
- CMS has also developed a variety of educational products and resources to help health care professionals and their staffs become familiar with coverage, coding, billing, and reimbursement for all preventive services covered by Medicare.
- The MLN Preventive Services Educational Products Web Page provides descriptions and ordering information for all provider specific educational products related to preventive services.
- The CMS Web site provides information for each preventive service covered by Medicare. Go to www.cms.hhs.gov and select "Medicare" and scroll down to the "Prevention" heading.
- For information to share with your Medicare patients, visit www.medicare.gov on the Web.
- For more information about National Nutrition Month please visit www.eatright.org.
RESOURCE SPOTLIGHT
Dyspnea Management Clinical Pathway
This clinical pathway guides clinicians through the steps of assessment and intervention fordyspnea. It includes patient education including pharmacological, nursing, and non-pharmacological interventions in the presence of dyspnea.
IN THE NEWS
IN-HOME CARE COULD CUT OUTLAYS
February 25, 2007 –- Cincinnati Enquirer –- If there's one change that could be done quickly and with little controversy, it's moving more Medicaid patients from institutions to home health care. Former Gov. Bob Taft encouraged in-home care – in a program called "Home First" – in his last budget passed in June 2005, allowing more people to be moved out of nursing homes and treated at home. Last year, nearly 1,000 Ohioans took advantage of the pilot program, saving an estimated $60 million in more costly nursing-home care. One senator has proposed expanding that program.
Nursing-home care is nearly five times more expensive for the elderly and mentally challenged than hiring nurses to care for those who are able to live at home, according to a recent study. Tending a person for a year using home care costs about $11,800 per year, while an institution runs about $56,000 per year, according to the Ohio Council for Home Care. Read more >>
EXPECT RISE IN NURSING-HOME COSTS, PRICES
February 26, 2007 –- The Columbus Dispatch –- Now that some Medicaid recipients are eligible for assisted living and now that Medicaid will pay for their care, the costs will increase greatly. Why? Because now that the state and federal governments control the money for care, they will mandate what they have forced on nursing homes.
Almost immediately, they will probably require assisted-living facilities to pay the franchise permit fee of $6.25 per day for each licensed bed, occupied or not, which amounts to $2,281.25 for each bed per year! It would cost a 50-bed facility $114,062.50 per year! Then they will require all the direct-care staff to be state-tested nursing assistants. The cost increase would be dramatic, as the supply of those assistants is limited and the demand greatly increased. These increases may be minimal compared with what may be required of the facilities’ physical structures. Sprinklers, emergency generators, 8-foot hallways, enunciator panels and smoke-detection equipment cost money. Is it any wonder the government pays $500 for a toilet seat? Read more >>
COMING ATTRACTIONS
ARE YOU READY FOR PAY FOR PERFORMANCE?
Attend one of these half-day meetings to learn more about:
- Current pay-for-performance demonstration projects.
- How Ohio agencies are performing on key measures.
- Best practices and barriers of Ohio agencies.
- Using tele-triage as a quality improvement strategy.
Choose the AM (9-12) or PM (1-4) session. Registration begins 30 minutes prior to the start of the conference. Register today for a meeting in your area:
- 3/20/07: Miamisburg (Dayton area)
- 3/21/07: Toledo
- 3/27/07: Akron
- 3/28/07: Dublin (Columbus area)
- 3/29/07: Dover (New Philadelphia/South Canton area)
- 4/4/07: Cleveland
Who should attend? CEO, Administrator, Operations, Director of Clinical Services, Nurses, or Quality Improvement Coordinator.
Click here for more information or to register now
Tracking Trends: Impacting the Practice of Medicine. Jointly sponsored by The Academy of Medicine of Cleveland & Northern Ohio, Academy of Medicine Education Foundation, and St. Vincent Charity Hospital. March 9, 2007, 9:00 a.m.-4:00 p.m., Embassy Suites, Independence, Ohio. Call 216.520.1000 for more information or to register by phone or visit www.amcnoma.org.
