CMS now says NPI must match IRS data

Anne Zieger — Wed, 18 Jun 2008 00:40:09 -0400

Providers have been going through some serious headaches already working to make sure they use their National Provider Identifier number properly to avoid getting claims bounced by Medicare. Now, CMS has raised the stakes again. In a move that surprised most observers, the agency announced that doctors will have to reconcile their NPI data with their IRS legal name data if they want to get their Medicare claims paid.

This is an extremely stringent requirement that should prove quite difficult to meet, experts say. Every aspect of a doctor's data must match in both databases, including exact name spellings, use of initials and even any blank spaces in the data. This new requirement only makes things worse for providers, many of whom continue to have trouble getting CMS to tell them why their claims are bouncing. All CMS will tell most physicians with NPI troubles is to start again with a new NPI enrollment, which could take months to process. Now, with the new and unexpected demand to match IRS data, providers could be faced with yet another reason for getting another NPI number.

To find out more about the new requirement:
- read this Healthcare Finance News article

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Insurer troubles could mean more bad debt for providers

Wed, 30 Apr 2008 06:59:58 -0400

In recent weeks, health insurers have started announcing financial results, and the news hasn't been good. WellPoint, for example, saw profits fall 25 percent, and UnitedHealth Group recently lowered its 2008 profit outlook by 40 cents per share. With insurers feeling financial pain, they're likely to raise premiums next year. In response, companies are likely to ask employees to carry more healthcare costs, industry watchers say. The net effect of all of this buck-passing is that with consumers facing higher bills, providers are likely to face high levels of bad debt, financial analysts predict. That's the case, in part, because consumers will be facing not only higher bills, but also a tougher economy and challenging job market, both of which further limit their ability to pay down medical debt. Add that to confusion over the use of the National Provider Identifier on Medicare claims--which could slow payments substantially--and 2009 is shaping up to be a very difficult year for providers, especially hospitals, healthcare analysts warn.

To learn more about this trend:
- read this InsideARM piece

Related Articles:
In 2007, bad debt rising for hospitals
HCA sees debt rising until patients get insured