Medicare, IRS kill doctors by alphabet soup

There’s this number called the “NPI.” The CMS (Center for Medicare and Medicaid or Can’t Manage S(tuff))mandated that any one and any corporation that bills them (for services already done, mind you) needed to add this number, the “National Provider Identifier,” by May 23 of this year. (Need I report that quite a few doctors haven’t been getting paid properly since? ) Well, out of the blue, the PTB (Powers that Be) sent down a little notice that the names associated with the NPI must now be identical to the ones that the IRS (Infernal Internal Revenue Service) has on file.

The NPI is in addition to the “UPIN” (Unique Provider Identifier Number) the DEA (Drug Enforcement Agency) number, a whole caboodle of state and insurance “identifiers,” and that pesky identifier that your mother, father, and husband gave you: your name.

The NPI also had to be acquired for any and each partnership or practice. Some people had one for themselves and one for their practice. Some did not receive their number for months. And, some were unable to get paid even with all the right numbers in the right place.

Now, many will have to start the application process all over if there’s a period after the “M” in “M.D.” or a space between the letters in their IRS files.

Here’s more from “Health IT News:”

Healthcare IT News
By Diana Manos, Senior Editor


WASHINGTON – Just when doctors thought things couldn’t get much worse, experts say, the Centers for Medicare & Medicaid Services has thrown another wrench into the already difficult transition to using National Provider Identifiers.

According to a June 11 CMS announcement, doctors will have to reconcile their NPI data with their IRS legal name data in order to get paid.

According to billing experts, this is a disaster waiting to happen. Every aspect of the data must match, including the exact spelling of names, the use of initials and even blank spaces in the data. The slightest discrepancy could send Medicare claims back to the drawing board. Don’t go getting married!

After a year-long contingency period, the use of NPIs was required by CMS as of May 23. Both before and since that deadline, doctors have had difficulty getting paid due to a host of complications with CMS and clearinghouse systems, experts say.

Cyndee Weston, executive director of the American Medical Billing Association, said the IRS matching requirement “has blindsided the whole industry.”

Weston, who works with small billing companies that submit claims for doctors, said many doctors who began using their NPI identifiers before the deadline have still not received Medicare reimbursements.

“This is going to affect all the doctors we work for. It’s going to kill their practices,” Weston said.

“I think we haven’t seen the worst of this yet. I think we’re going to see a big uprising if this continues. No way around it.”

Martin Jensen, chief operating officer and chief analyst at the Healthcare IT Transition Group, a consulting group specializing in helping doctors get paid, said physicians aren’t getting consistent answers from the CMS or its intermediaries as to what’s blocking the claims. The added stress of matching NPI to IRS data is going to compound their troubles.

“This IRS thing is very immediate and one we didn’t anticipate,” Jensen said. “It’s definitely going to set off a cascade of mismatches to data.”

The answer most physicians are getting from CMS is to start over with a new NPI enrollment. This could take months, Jensen said. Even doctors who have successfully had their claims paid under NPI could be forced to start over if their IRS data doesn’t match, he added.

Are you a provider experiencing difficulty getting paid under NPI? Share your experiences with Senior Editor Diana Manos at diana.manos@medtechpublishing.com.

I don’t believe that doctors will actually quit work. Who can, unless our spouse has a good income or we were independently wealthy to begin. What’s going to happen is that many more docs will “opt out,” or quit accepting Medicare or Medicaid. With the threatened 15%- 20% cut looming over our heads, the extra work and uncertain payment, along with the threat of legal consequences and now no payment) if one comma, period, or space is out of place, I’m not sure I would trust a doc stupid enough to try to play the game.

About bnuckols

Conservative Christian Family Doctor, promoting conservative news and views. (Hot Air under the right wing!)


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