Alert: PQRI participation credit/bonus will be affected if clearinghouse strips NPI from Medicare claim forms.

The U.S. Centers for Medicare and Medicaid Services (CMS) reports that some clearinghouses are stripping the National Provider Identifier (NPI) from claim forms prior to submitting them to Medicare. The NPI is an essential component of the Physician Quality Reporting Initiative (PQRI). Claims submitted to Medicare without the NPI will not count toward the provider’s participation in PQRI, or be included when CMS calculates the 1.5 percent bonus. To quality for the bonus, physicians need to report on at least three quality measures on 80 percent of eligible patients on claims submitted between July 1 and Dec. 31, 2007. CMS urges providers who use clearinghouses to contact the clearinghouse to ensure that the NPI is included on all claims. For more information on how to use the NPI correctly on Medicare Part A and Part B claims, read the special edition of MLN Matters on the CMS Web site at:

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf (Acrobat reader required)

CMS is hosting a National Roundtable/NPI question-and-answer session on common billing and enumeration errors for Medicare fee-for-service providers on Thursday, August 2 from 2:00-3:30 p.m. EDT. If you or your staff plan to participate, you should review the special MLN Matters SEO725 article (above) before the call. The session is free, but registration is required at:

http://www2.eventsvc.com/palmettogba

Finally, for more information on PQRI, visit the AAOS Web site for orthopaedic-specific measures, worksheets and codes at:

http://www.aaos.org/pqri