Brand new federal requirement: NPI needs to match IRS data

Really, it’s like they don’t want docs to use the Government system…

Brand new federal requirement: NPI needs to match IRS data
Brand new federal requirement: NPI needs to match IRS data
Healthcare IT News
By Diana Manos, Senior Editor

WASHINGTON – Just when doctors thought things couldn’t get much worse, experts say, the Centers for Medicare & Medicaid Services has thrown another wrench into the already difficult transition to using National Provider Identifiers.

According to a June 11 CMS announcement, doctors will have to reconcile their NPI data with their IRS legal name data in order to get paid.

I read to there, and thought, ‘well, that’s not entirely unreasonable’.  What an idiot I am.

According to billing experts, this is a disaster waiting to happen. Every aspect of the data must match, including the exact spelling of names, the use of initials and even blank spaces in the data. The slightest discrepancy could send Medicare claims back to the drawing board.

Aah.  So, Medicare issues a NPI, which isn’t checked against the IRS name, then retroactively and apparently without notice announces they’re not going to pay for work already done in good faith, over yet another clerical gotcha, in which they were complicit.  Breathtaking, the hubris.

After a year-long contingency period, the use of NPIs was required by CMS as of May 23. Both before and since that deadline, doctors have had difficulty getting paid due to a host of complications with CMS and clearinghouse systems, experts say.

Cyndee Weston, executive director of the American Medical Billing Association, said the IRS matching requirement “has blindsided the whole industry.”

I might actually join the AMA if they said ‘no more’ to this crap.  Unfortunately, I suspect they’ll hold their hat in their hands, appoint a commission, and say pretty please.

Bait & Switch.  They’d never dare pull this crap on lawyers.


  1. Darrell Pruitt DDS says:

    I tend to agree. It appears that the inclusion of the IRS is just one more hoop to clear in order to be paid for work long ago completed.

    When there is a bureaucratic screw up from any part of any of the complicated requirements, it always means delayed payment to providers. As inflation creeps up, stakeholders like CMS and insurance companies will celebrate windfall profits from crosswalk delays – intentional or not.

    Long ago, I was not cynical.

  2. A few clarifications and updates. Re: “Every aspect of a doctor’s data must match in both databases, including exact name spellings, use of initials and even any blank spaces in the data.” The two primary databases that impact Medicare crosswalk logic are NPPES (the NPI database, which providers can update online) and PECOS (the Medicare enrollment database, which is based on information from providers’ 855 forms, which Medicare contractors update by hand, often months after the forms are submitted). Medicare keeps advising providers to submit these complex enrollment forms to fix NPI problems, without informing them that their claims will continue to be rejected for weeks or months.

    The new IRS data matching applies only to organizational providers, and only to the Employer Identification Number (EIN) and Legal Busines Name. Medicare has not revealed which IRS data source they are using, so providers need to rely on the information in letters which were to begin mailing last week.

    Also, the “exact name spellings, use of initials and even any blank spaces in the data” is correct in terms of what providers have reported in the past, but a new document has come to light that suggests that the crosswalk logic may be more sophisticated than that, perhaps in response to such complaints. Still, Medicare has refused to publish the crosswalk logic and has not announced any plans to accelerate 855 processing or to prioritize NPI crosswalk error problem resolution.

    A copy of the crosswalk logic, with an analysis of new IRS matching requirements, can be found on my blog at First Look: CMS NPI Crosswalk Logic and IRS Change Impacts.

  3. We had a screw-up with the NPIs of our hospitalist group, resulting in $160K of billings being delayed. Payroll has been meager. One of our staff swears he’s facing bankruptcy. There are real consequences to all this bureaucracy. Sigh.

  4. Nurse 1961 says:

    One more reason to delay payment. As if jumping through the hoops is not bad enough, they have now set the hoops on fire to see how many people will continue to play the game.

  5. Cool! Our Medicare carrier has spent the last two months rejecting claims because they were not ready for it (even though we were mandated to be so). This will be another chance for me to file claims that may never be paid. Oh, and by the way, over half of the insurance companies we work with have also been unable to meet the NPI dateline, so we are getting claims denied by them as well. Isn’t it great when the government is so heavily involved with medicine!

  6. TheNewGuy says:

    It almost makes you want to walk away, and let somebody else deal with all this crap.

  7. Pharmacy has been dealing with this crappola too. It’s going to be a big park bench of people saying “To hell with it” and leave the professions.

  8. What’s amazing is how every “improvement” just makes things worse and worse. Thank God I take care of kids, so Medicare doesn’t directly affect me.

    “They’d never dare pull this crap on lawyers.”

    That’s because lawyers WRITE this crap.

  9. I’ve been involved in taxations for lengthier then I care to admit, both on the private side (all my employed life history!!) and from a legal standpoint since passing the bar and following up on tax law. I’ve put up a lot of advice and corrected a lot of wrongs, and I must say that what you’ve put up makes perfect sense. Please persist in the good work – the more individuals know the better they’ll be equipped to handle with the tax man, and that’s what it’s all about.


  1. […] over our health care delivery system will make things more efficient, I recommend GruntDoc’s latest post on the boondoggle known as […]