News from the AOA's Blog

Effective Jan. 4, 2011, the U.S. Centers for Medicare & Medicaid Services (CMS) will require all health care practitioners who provide services for Medicare patients to have a valid National Provider Identifier (NPI) in their Medicare enrollment records.

Beginning next year, the CMS has ordered Medicare carriers to crosscheck the NPIs on claims against the identifiers in Medicare enrollment records.

When an NPI cannot be found for a practitioner in the Medicare records, claims will be rejected, the agency warns.

Virtually all health care practitioners already have NPIs, the AOA Advocacy Group staff notes.

However, many established Medicare practitioners have never updated their Medicare records to include those NPIs, they warn.

All physicians who service the Medicare population enrolled at some point when they first began to see Medicare patients, the AOA Advocacy Group notes.

Since November 2003, physician enrollment records began to be collected in the database known as the Provider Enrollment, Chain, and Ownership System (PECOS). 

Only since 2007 have doctors obtained and used NPIs.

Thus, only doctors who have enrolled or re-enrolled in Medicare since 2007 are likely to have their NPIs in their enrollment records.

Even doctors who have enrollment records in PECOS from 2003 to 2007 may need to update their files, the AOA Advocacy Group emphasizes.

The CMS has added NPIs to some enrollment records that are in the PECOS database.

Any practitioner whose enrollment records are already in PECOS should check the records to confirm that the NPI is part of the file and follow CMS instructions for updating the records if necessary. 

Any practitioner whose enrollment records are not in PECOS probably will need to re-enroll in Medicare to be able to add the NPI to the file. 

Practitioners should contact their Medicare Part B contractors or carriers to check whether there is an NPI in their enrollment records and, if not, inquire how to add the NPI to ensure continued payments in 2011.

“The NPI requirement will effectively force any physician who does not have a complete Medicare enrollment record in the PECOS database to re-enroll in Medicare,” said AOA Advocacy Group Director Jon Hymes.

For additional information see the AOA Web site PECOS page (www.aoa.org/PECOS).