1.19.07 - Issue # 254 Forward This Newsletter To A Colleague


Belle DuCharme CDPMA
Instructor/Consultant
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Have You Registered Your NPI and Updated
Your CDT Codes?

If you haven’t had enough of OSHA and HIPAA, now there is NPI and CDT.  For those new Office Managers enrolled in training at McKenzie’s Advanced Training Center, these abbreviations are a new language of great importance.

Effective May 23, 2007, Federal Law prohibits Health Insurance Carriers from accepting certain types of electronic transactions from any health care provider unless the provider has first obtained and is using its NATIONAL PROVIDER IDENTIFIER or NPI.

What is an NPI?  It is the standard unique identifier for health care providers to use in electronic transactions.  It was mandated as part of the Health Insurance Portability and Accountability Act or HIPAA. After May 23, 2007, Federal regulations prohibit payers from accepting any electronic transactions submitted by you, the dentist, if you have not obtained and are not using your NPI.

Individuals will use just one unique provider number to identify themselves to all health plans through which they are employed.  You will not have to change your NPI even if you relocate or change specialties.  The positive is health plans will be able to more efficiently coordinate benefits and track transactions.  Clearinghouses are also required to be able to accept and transmit the NPI by the federal compliance deadline of May 23,2007.

If you do not submit electronic transactions governed by HIPAA, you are not required to obtain an NPI.  You should get one regardless.  Technology is a force to be reckoned with and you have to keep up with it for the value of your practice today and tomorrow.

How to apply?  The application form, available at http. //nppes.cms.hhs.gov, can be submitted free of charge either on paper or electronically.  You may apply for an NPI now, so that you will be ready to use it on all HIPAA governed transactions by the compliance date.  If there are any changes after you have been assigned an NPI, you will need to submit the new information to the National Plan and Provider Enumeration System (NPPES) within 30 days of the change.

Without an NPI, not only will you not be able to submit claims electronically, but you will not be able to check claim status or get online benefits or eligibility inquiries.  After obtaining your NPI, contact your software provider and ask how to load the NPI in the system.  Updated software will have a window in which you may type the NPI so that it will show on all claims going out.  You may also submit your NPI to each individual insurance carrier.  Notices have been coming in the mail with instructions of where to send your NPI.

Now for CDT.  The newest version of the ADA’s Current Dental Terminology or CDT 2007/2008 went into effect January 1, 2007.  This notice is to let dental offices know about the CDT changes and their implementations affecting claim submissions.  The CDT 2007/2008 codebook contains 23 new codes, three deleted codes and various changes to nomenclature and other text.  Two of the deletions will have an impact on many dental offices because the codes were used frequently. The frequently used codes that were deleted are D1201 Topical application of fluoride (including prophylaxis for child and D1205 Topical application of fluoride (including Prophylaxis for adult).  You must now separate these procedures by using two codes.  The code for prophylaxis D1110 adult and D120 Child and the code for fluoride D1203 and D1204 and D1206 provided on the same date of service.  For more information on these deleted codes and new nomenclature get your updated codebook today.  For efficient and speedy return on your claims it is important to keep up with the yearly changes that affect claim submission.  If a deleted code is submitted for payment it will cause the claim to be denied for payment.  This can be costly and time consuming for offices as they have to resubmit and wait again for payment.

If coding claims is confusing and you want individualized training we can customize your Advanced Business Training to answer your toughest questions about maximizing return on your claims.  Call today for more information and make this a year of prosperity for your practice.

For more information on McKenzie's Advanced Training for Front Office and Office Managers, email training@mckenziemgmt.com, call `1-877-777-6151 or visit our web-site at http://www.mckenziemgmt.com/

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