Medicare Billing Challenges for Deceased Providers: Expert Advice
I had this posted on my blog site. Not knowing the answer, I posed it to my colleagues at the National Society of Certified Healthcare Consultants (www.nschbc.org); their answers follow the blog post:
Have a provider who is deceased after obtaining an NPI # which is now deactivated from NPPES site and now NGS contractor for Medicare in NY cannot crosswalk their system to NPPES to verify his NPI. NGS system has NPI # as not active. Cannot get NPPES to reactivate his NPI # so I can get claims prior to his death processed. Now the EDI Dept to send claims will not accept his claims electronically due to their system not accepting his NPI. Want to send claims on paper but afraid they will refuse this process due to him not having a waiver letter on file to process claims on paper and he was only allowed to do them electronically. I am in a bind...seems like I have the first deceased provider in the city of NY that I am trying to bill. Also Medicaid is forcing me to send claims on paper due to his Electronic cert expiring and no one can sign for him..since it has to be his notarized signature. Please can you assist me in this matter or direct me to where I can get help. Thank you Susan
From: Ginny Martin, CMA,CPC,CHCO,CHBC
Healthcare Consulting Associates of NW Ohio, Inc.
Reed,
I'm wondering what was conveyed to NPPES regarding this provider's death. Any change requires an effective date and whoever updated his file possibly used an incorrect date. She needs to call NPPES (I have spoken to them on numerous occasions and have found them to be very helpful) explain the situation and indicate she still has claims to file. She will then need to go to CAQH once NPPES is corrected and correct any misinformation there, making sure the deactivation effective date is after the last date of service. It will take approximately 30 days for insurers to upload the file and they should process all claims with dates of service prior to the effective date. The rest will be fixed when those two things are fixed.
She should have attempted to do that as soon as she got the 1st rejection, since now things appear to have escalated and will require a lot of effort to fix. This is my best guess based upon the information in her blog.
Hope that is helpful.
Ginny
From: David J Zetter
www.cavmich.com
Ginny is absolutely right. NPPES will follow YOUR lead and information YOU provide. The date should have been the last date of service provided by the physician.
Call this number 1-800-465-3203 (NPI Toll-Free)
From: Kathryn Moghadas, RN, CLRM, CHBC, CHCC, CPC
Principal of Associated Healthcare Advisors
Dang good questions today! Someone must have power of attorney to act on his behalf. With the proper POA on hand a limited POA can be issued to the billing office manager which will assist her in remedy his NPPES status. We talk to NPPES frequently and they are real helpful and usually kind in our experience. Once that is cured then it is a systematic process of paper filing. Since he probably does not have electronic agreements on file they will have to just be scrupulous in their hard copy filings. Kathy
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