CMS alert re PQRI and clearinghouses

From the allbusiness.com doctor office blog: https://www.allbusiness.com/services/health-services-offices-clinics-doctors/4353817-1.html

This alert was posted by CMS today. It applies to practices who are participating in the 2007 Physician Quality Reporting Initiative (PQRI) and use a clearinghouse to process claims:

It has come to the attention of Centers for Medicare & Medicaid Services (CMS) that some Clearinghouses are stripping the National Provider Identifier (NPI) prior to submission of the claim to Medicare.  This will adversely affect Eligible Professionals in that these claims will not count toward PQRI participation. CMS urges Eligible Professionals that use clearinghouses to check with their clearinghouse to assure NPIs are not being stripped from claims. If the Eligible Professional determines that their clearinghouse is stripping NPIs from the claim, the Eligible Professional may want to consider other billing options.

A recent Special Edition MLN Matters article contains important information for Medicare providers and suppliers, including how to use the NPI correctly on Part A and Part B claims.  You can view this article by visiting http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf on the CMS website.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.