Step-by-Step Coding Guide for Item Set A0100A: Facility National Provider Identifier (NPI)

This guide aims to assist in accurately coding and documenting the Facility National Provider Identifier (NPI) in the MDS 3.0, specifically within item A0100A.

1. Review of Medical Records

• Objective: Identify the facility's NPI.
• Key Points:
  • The NPI is a unique identification number for covered health care providers in the United States.
  • Check facility-related documents, such as billing records, official correspondence, or contractual agreements, where the NPI is likely to be recorded.

2. Understanding Definitions

• Objective: Clarify the concept of a National Provider Identifier (NPI).
• Key Points:
  • NPI (National Provider Identifier): A 10-digit numerical identifier assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS). It's used in administrative and financial transactions under HIPAA.

3. Coding Instructions

• Objective: Provide guidance on entering the facility's NPI.
• Key Points:
  • Enter the 10-digit NPI number of the facility without spaces, dashes, or other separators.

4. Coding Tips

• Double-check the NPI number for accuracy before entering it into the MDS to avoid errors in billing and reporting.
• Ensure the NPI used is specific to the facility, not an individual provider or a different location within the same organization.

5. Documentation

• Objective: Ensure the NPI is properly documented within the facility’s records.
• Key Points:
  • Maintain a record of the NPI in an easily accessible location for reference when completing administrative and billing tasks.
  • Document the source of the NPI verification, such as the CMS NPI registry or official facility documentation, in the facility’s policy and procedure manual or similar records.

6. Common Errors to Avoid

• Using an incorrect NPI that belongs to an individual provider or a different facility.
• Transcription errors that could result from misreading or incorrectly typing the NPI.

7. Practical Application

• Scenario: While preparing to submit quarterly MDS assessments for Medicare reimbursement, the billing coordinator verifies the facility’s NPI by consulting the CMS NPI registry online and cross-references it with the facility’s official billing documentation. The correct 10-digit NPI is then accurately coded into item A0100A of each resident’s MDS assessment. This step ensures that all submitted assessments are associated with the right facility, facilitating proper processing and reimbursement.

The Step-by-Step Coding Guide for item A0100A in MDS 3.0 Section A is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.