Re: Medicare glitches with new NPI number

[Guest guest]

,

I am so sorry to hear about your troubles with Medicare.

I had to move my office in mid August. This was my first move ever as a nonparticipating provider. The fascinating thing that happened to me with this move is my patients experienced NO DELAY in payment to them by Medicare due to my move. (I had warned my patients about Medicare's nasty habit of taking a 3 month intrest-free loan from doctors for no apparent reason anytime a doctor changed their address. They still received their reimbursement checks within 3 weeks of me submitting their HCFA 1500. I guess Medicare does not want to inflame the wrath of the people, but could care less about putting doctors a month behind on rent!)

I, on the other hand, experienced the usual 2-3 month delay on the people I chose to take assignment on and the labs that I had to take assignment on. We actually were getting secondary checks sent to me before Medicare started reimbursing me. WEIRD.

I will never return to participating status with Medicare ever again.

Durango, CO

Is anybody who bills Medicare having trouble because of glitches withthe new NPI number? Medicare N. Calif. (NHIC)stopped sending me checksin mid August. Apparently they are having some problem with theircomputer system matching the new NPI with the old numbers. They are

getting my NPI OK from the clearinghouse but apparently their softwareis trying to say it doesn't match with my old ID numbers, but isinstead trying to match it to a group number I had from a group from

which withdrew back in 2004 and my NPI does not match the NPI fromthat group, or something like that, if I am to believe what they aretelling us. I read a small article about 2 weeks ago in the weekly AMAnews that this is a problem all over the country. One other doc in

town says the same thing is happening to him.I Had to re-enroll in Medicare when I went solo in 2004, which causeda 4 month delay in payments, then had to endure another 3 month delayin payments last fall, just because I moved 2 doors down the street

and needed to change the address with them. Now a 2 1/2 month delaybecause of their computer problem. I have over 55% Medicare in mypractice. I'm now a month behind on my rent. CaldwellTulare, CA

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[Guest guest]

RE endless paperwork and added overhead in delay of payment.

This is the reason some docs (yes, even on this list!) use some of their resources to get this part of practice up and running as well as troubleshooting.

Took me 10 months to get Medicare to acknowledge that I'd left the hospital group BUT took that time to get info that the group number at hosp was discontinued, only to find my ORIGINAL number from 8 years prior had been sort of "retired."

Go to Congressman -- they work for you and you shouldn't have to be behind on rent.

Then consider a billing co OR a "practice consultant" to do a "one time review" of this stuff to be sure you're not leaving other issues unresolved.

Remember, you wouldn't do brain surgery and some of this regulatory stuff is just as complex and messy.

Glad I use outside company to do this -- and yes, I pay them.

Contrarian point of view, again....

Matt from Western PA

Re: Medicare glitches with new NPI number

It may be the same problem I'm talking about they have this crazycomputer thing called a "crosswalk" that is supposed to match younew NPI to your old ID no's but they are getting some problems dueto people having different old legacy ID's in the system and/orpossibly getting the wrong type of NPI no. MDOn-line the clearinghouse I use sent out this info today:"By October 31, 2007, all Medicare carriers (and A/B MACs that service providers who formerly billed carriers) will be rejecting Part Bclaims if they are unable to match a NPI and a PIN combination submitted on aclaim to an NPI/PIN combination in the Medicare NPI crosswalk. The NPI/PIN combination may be used to identify the Billing, Pay-to, or Rendering Provider (the Pay-to Provider is identified only if it isdifferent from the Billing Provider). This applies to claims that are submitted by corporations that physicians and non-physician practitioners haveformed, or by physicians and non-physician practitioners who bill Medicare directly. Check your information in the NPPES to ensure that the NPI(s) wereproperly obtained. For example, if you are a sole proprietor, you should have an individual PIN and you should have obtained an NPI as an Individual(Entity type 1), not as an Organization (Entity type 2). Ensure that the NPPES data are correct, and that the NPPES record(s)contains the Medicare legacy identifier(s) that was assigned to the provider towhom the NPPES record belongs. For example, a physician/practitionerapplying for an NPI would list his/her Medicare PIN in the Other ProviderIdentifiers section of the NPI application, but would not list the PIN of thegroup in which he/she is a member. Medicare uses this information in building the Medicare NPI crosswalk and incorrect reporting will flow into the NPI crosswalk and cause problems down the road. To view or edit your NPPESrecord, go to https://nppes.cms.hhs.gov on the CMS Web site. For assistance,call the NPI Enumerator at 1-. If the NPI(s) was properly obtained and the NPPES information iscorrect and you continue to get informational NPI edits:Ensure that your Medicare enrollment information is up to date. If you need to re-enroll or update the enrollment information, ensurethat a complete application is submitted. Make sure that the Medicare enrollment record reflects the correctTaxpayer Identification Number (TIN) for use by Medicare in reporting yourincome to the IRS on the 1099 form." CaldwellTulare, CA>> I went through he same problem with medicare. I moved and checkswere held > up for 4 mos. I finally contacted my congresswoman and checks werereleased > 3 days later. but, now checks are again held up due to another glitch--not > sure what, my biller is working it out.> > Mala> > > > > > ************************************** See what's new athttp://www.aol.com>

[Guest guest]

, Matt, , DocSingh

Thanks for the advice and encouragment. It really is getting me

thinking about participating (that's what I am now) vs. non-

participating or opting out.

I think I'm pretty brave, I am using my own home made EMR, and have

not been afraid to get into some of the technicalities of billing

etc. I think the current problem I have really is on their side and

there is not too much I can do about except wait, unless maybe I

could get the patients to form an alliance on my behalf and do a sit

in, phone assault on NHIC or something like that. I also built and

flew my own home made airplane, check out

www.youtube.com/watch?v=6m1ImU95CCc so I'm not a chicken in general,

but I don't just don't think I have the courage and guts to opt out

of Medicare yet. It just seems like in this community that's where

I'm needed and I don't think the patients would be able to see me

without Medicare. But I'm thinking about it!

Caldwell

Tulare, CA

> >

> > I went through he same problem with medicare. I moved and

checks

> were held

> > up for 4 mos. I finally contacted my congresswoman and checks

were

> released

> > 3 days later. but, now checks are again held up due to another

> glitch--not

> > sure what, my biller is working it out.

> >

> > Mala

> >

> >

> >

> >

> >

> > ************************************** See what's new at

> http://www.aol.com

> >

>

[Guest guest]

Hi group,Here's where I am re Medicare. Again, I will demonstrate my naivete, no doubt. As many of you know, I opened my solo cash based practice in late June. I never enrolled in Medicare. I had intended to officially opt out, but never did because I am a bit intimidated by the two year rule (once you opt out, you can't opt back in for 2 years). So I guess I am in some sort of no man's land with Medicare now. I think I could see someone with Medicare, and they can pay me, but they can't get reimbursed for it because Medicare doesn't really know who I am, since I never enrolled. I'm not exactly sure what the difference between where I am now and opting out is. I am reluctant to enroll for oh so many reasons. There are all the usual insurance reasons, plus more. Santa Cruz is one of those locality 99 areas that gets reimbursed at a lower rate in spite of a very high cost of living. For this reason,

I don't know of ANY docs in town that take new medicare patients (There may be some, but I don't know of them). If I were to take Medicare participating or not, I think I could be inundated with new very complicated patients. On the other hand, I would like SOME older patients ...Like everything else, my thoughts on it are a work in progress.Lonna Caldwell wrote: , Matt, , DocSingh Thanks for the advice and encouragment. It really is getting me thinking about participating (that's what I

am now) vs. non- participating or opting out. I think I'm pretty brave, I am using my own home made EMR, and have not been afraid to get into some of the technicalities of billing etc. I think the current problem I have really is on their side and there is not too much I can do about except wait, unless maybe I could get the patients to form an alliance on my behalf and do a sit in, phone assault on NHIC or something like that. I also built and flew my own home made airplane, check out www.youtube.com/watch?v=6m1ImU95CCc so I'm not a chicken in general, but I don't just don't think I have the courage and guts to opt out of Medicare yet. It just seems like in this community that's where I'm needed and I don't think the patients would be able to see me without Medicare. But I'm thinking about it! Caldwell Tulare, CA > > > > I went through he same problem with medicare. I moved and checks > were held > > up for 4 mos. I finally contacted my congresswoman and checks were > released > > 3 days later. but, now checks are again held up due to another > glitch--not > > sure what, my biller is working it out. > > > > Mala > > > > > > > > > > > > ************************************** See what's new at > http://www.aol.com > > >

__________________________________________________

[Guest guest]

Might be able to get some guidance from local medical society

M in Western PA

Re: Re: Medicare glitches with new NPI number

Hi group,Here's where I am re Medicare. Again, I will demonstrate my naivete, no doubt. As many of you know, I opened my solo cash based practice in late June. I never enrolled in Medicare. I had intended to officially opt out, but never did because I am a bit intimidated by the two year rule (once you opt out, you can't opt back in for 2 years). So I guess I am in some sort of no man's land with Medicare now. I think I could see someone with Medicare, and they can pay me, but they can't get reimbursed for it because Medicare doesn't really know who I am, since I never enrolled. I'm not exactly sure what the difference between where I am now and opting out is. I am reluctant to enroll for oh so many reasons. There are all the usual insurance reasons, plus more. Santa Cruz is one of those locality 99 areas that gets reimbursed at a lower rate in spite of a very high cost of living. For this reason, I don't know of ANY docs in town that take new medicare patients (There may be some, but I don't know of them). If I were to take Medicare participating or not, I think I could be inundated with new very complicated patients. On the other hand, I would like SOME older patients ...Like everything else, my thoughts on it are a work in progress.Lonna Caldwell <alcald2000> wrote:

, Matt, , DocSinghThanks for the advice and encouragment. It really is getting methinking about participating (that's what I am now) vs. non-participating or opting out. I think I'm pretty brave, I am using my own home made EMR, and have not been afraid to get into some of the technicalities of billing etc. I think the current problem I have really is on their side and there is not too much I can do about except wait, unless maybe I could get the patients to form an alliance on my behalf and do a sit in, phone assault on NHIC or something like that. I also built and flew my own home made airplane, check outwww.youtube.com/watch?v=6m1ImU95CCc so I'm not a chicken in general,but I don't just don't think I have the courage and guts to opt out of Medicare yet. It just seems like in this community that's where I'm needed and I don't think the patients would be able to see me without Medicare. But I'm thinking about it! CaldwellTulare, CA> >> > I went through he same problem with medicare. I moved and checks> were held > > up for 4 mos. I finally contacted my congresswoman and checks were> released > > 3 days later. but, now checks are again held up due to another > glitch--not > > sure what, my biller is working it out.> > > > Mala> > > > > > > > > > > > ************************************** See what's new at> http://www.aol.com> >>

__________________________________________________

[Guest guest]

My advice would be to opt in. You can designate yourself as

non-participating. The fact that you have a PTAN will allow you to

contract w/Part C plans. As non-par, you can explain to your patients

that you bill Medicare unassigned on their behalf. They should receive

95% of Medicare's non-par allowable. This situation will restrict you

in collecting up to 115% of the allowable from the patient .

Lonna Larsh wrote:

>

> Hi group,

>

> Here's where I am re Medicare. Again, I will demonstrate my naivete,

> no doubt. As many of you know, I opened my solo cash based practice

> in late June. I never enrolled in Medicare. I had intended to

> officially opt out, but never did because I am a bit intimidated by

> the two year rule (once you opt out, you can't opt back in for 2

> years). So I guess I am in some sort of no man's land with Medicare

> now. I think I could see someone with Medicare, and they can pay me,

> but they can't get reimbursed for it because Medicare doesn't really

> know who I am, since I never enrolled. I'm not exactly sure what the

> difference between where I am now and opting out is.

> I am reluctant to enroll for oh so many reasons. There are all the

> usual insurance reasons, plus more. Santa Cruz is one of those

> locality 99 areas that gets reimbursed at a lower rate in spite of a

> very high cost of living. For this reason, I don't know of ANY docs

> in town that take new medicare patients (There may be some, but I

> don't know of them). If I were to take Medicare participating or not,

> I think I could be inundated with new very complicated patients.

> On the other hand, I would like SOME older patients ...

> Like everything else, my thoughts on it are a work in progress.

> Lonna

>

> */ Caldwell /* wrote:

>

> , Matt, , DocSingh

>

> Thanks for the advice and encouragment. It really is getting me

> thinking about participating (that's what I am now) vs. non-

> participating or opting out.

> I think I'm pretty brave, I am using my own home made EMR, and have

> not been afraid to get into some of the technicalities of billing

> etc. I think the current problem I have really is on their side and

> there is not too much I can do about except wait, unless maybe I

> could get the patients to form an alliance on my behalf and do a sit

> in, phone assault on NHIC or something like that. I also built and

> flew my own home made airplane, check out

> www.youtube.com/watch?v=6m1ImU95CCc so I'm not a chicken in general,

> but I don't just don't think I have the courage and guts to opt out

> of Medicare yet. It just seems like in this community that's where

> I'm needed and I don't think the patients would be able to see me

> without Medicare. But I'm thinking about it!

>

> Caldwell

> Tulare, CA

>

>

> > >

> > > I went through he same problem with medicare. I moved and

> checks

> > were held

> > > up for 4 mos. I finally contacted my congresswoman and checks

> were

> > released

> > > 3 days later. but, now checks are again held up due to another

> > glitch--not

> > > sure what, my biller is working it out.

> > >

> > > Mala

> > >

> > >

> > >

> > >

> > >

> > > ************************************** See what's new at

> > http://www.aol.com <http://www.aol.com>

> > >

> >

>

>

> __________________________________________________

>

[Guest guest]

Yes the clearing house had problems getting the NPI number correct

and it slowed down payment tremendously. That was back in July and it

took quite a bit of detective work to find where the problem was.

Brent

>

> Is anybody who bills Medicare having trouble because of glitches

with

> the new NPI number? Medicare N. Calif. (NHIC)stopped sending me

checks

> in mid August. Apparently they are having some problem with their

> computer system matching the new NPI with the old numbers. They are

> getting my NPI OK from the clearinghouse but apparently their

software

> is trying to say it doesn't match with my old ID numbers, but is

> instead trying to match it to a group number I had from a group from

> which withdrew back in 2004 and my NPI does not match the NPI from

> that group, or something like that, if I am to believe what they are

> telling us. I read a small article about 2 weeks ago in the weekly

AMA

> news that this is a problem all over the country. One other doc in

> town says the same thing is happening to him.

>

> I Had to re-enroll in Medicare when I went solo in 2004, which

caused

> a 4 month delay in payments, then had to endure another 3 month

delay

> in payments last fall, just because I moved 2 doors down the street

> and needed to change the address with them. Now a 2 1/2 month delay

> because of their computer problem. I have over 55% Medicare in my

> practice. I'm now a month behind on my rent.

>

> Caldwell

> Tulare, CA

>

[Guest guest]

Here's an article in AMA News from Oct. 1 regarding Medicare's

problems with the new NPI number and their " Crosswalk " that

is apparantly where the problem is coming from. Their only knee

jerk response to their own internal problems is to reject claims and

delay payment. It fits with my experience. In our case, the problem is

not with the clearinghouse which is sending them the right numbers,

it's their own internal " Crosswalk " software that could not match the

proper NPI with the proper old ID numbers.

http://www.ama-assn.org/amednews/2007/10/01/gvsa1001.htm

I talked to another doctor in Tulare who is using Practice Partner

and he is having the same trouble. In our latest phone call to NHIC,

they say they have it fixed and are working on our claims, but may be

2 weeks before we see any check. We'll see what happens.

Caldwell

Tulare

> >

> > Is anybody who bills Medicare having trouble because of glitches

> with

> > the new NPI number? Medicare N. Calif. (NHIC)stopped sending me

> checks

> > in mid August. Apparently they are having some problem with their

> > computer system matching the new NPI with the old numbers. They are

> > getting my NPI OK from the clearinghouse but apparently their

> software

> > is trying to say it doesn't match with my old ID numbers, but is

> > instead trying to match it to a group number I had from a group from

> > which withdrew back in 2004 and my NPI does not match the NPI from

> > that group, or something like that, if I am to believe what they are

> > telling us. I read a small article about 2 weeks ago in the weekly

> AMA

> > news that this is a problem all over the country. One other doc in

> > town says the same thing is happening to him.

> >

> > I Had to re-enroll in Medicare when I went solo in 2004, which

> caused

> > a 4 month delay in payments, then had to endure another 3 month

> delay

> > in payments last fall, just because I moved 2 doors down the street

> > and needed to change the address with them. Now a 2 1/2 month delay

> > because of their computer problem. I have over 55% Medicare in my

> > practice. I'm now a month behind on my rent.

> >

> > Caldwell

> > Tulare, CA

> >

>

[Guest guest]

I got my first check from Medicare today since they stopped

paying me Sept. 1. So I'm now getting reimbursement for work done in

late August and early Sept. So it looks like I had an almost two

month hiatus in Medicare payments because of the NPI number problem.

Now I hope to pay my back rent.

Caldwell

Tulare, CA

> > >

> > > Is anybody who bills Medicare having trouble because of

glitches

> > with

> > > the new NPI number? Medicare N. Calif. (NHIC)stopped sending

me

> > checks

> > > in mid August. Apparently they are having some problem with

their

> > > computer system matching the new NPI with the old numbers.

They are

> > > getting my NPI OK from the clearinghouse but apparently their

> > software

> > > is trying to say it doesn't match with my old ID numbers, but

is

> > > instead trying to match it to a group number I had from a

group from

> > > which withdrew back in 2004 and my NPI does not match the NPI

from

> > > that group, or something like that, if I am to believe what

they are

> > > telling us. I read a small article about 2 weeks ago in the

weekly

> > AMA

> > > news that this is a problem all over the country. One other

doc in

> > > town says the same thing is happening to him.

> > >

> > > I Had to re-enroll in Medicare when I went solo in 2004, which

> > caused

> > > a 4 month delay in payments, then had to endure another 3

month

> > delay

> > > in payments last fall, just because I moved 2 doors down the

street

> > > and needed to change the address with them. Now a 2 1/2 month

delay

> > > because of their computer problem. I have over 55% Medicare

in my

> > > practice. I'm now a month behind on my rent.

> > >

> > > Caldwell

> > > Tulare, CA

> > >

> >

>