Next May, providers will begin using the new NPI, a 10-digit number to be used in all healthcare billing procedures mandated under the Health Insurance Portability and Accountability Act. NPIs are intended to streamline providers’ billing processes, but as the compliance deadline comes into view, so do the accompanying pitfalls of the transition.
The NPI simplifies financial processes by replacing the current system, in which providers often find themselves using many different identifying numbers to bill payers for procedures. Now, each hospital, IDN or group practice will be assigned one general NPI, and each individual care provider within those organizations will carry a personal NPI.
Evan Coppola, a lawyer for Blue Cross and Blue Shield Vermont who advises providers on NPI compliance and aspects of the HIPAA rule, said the challenge for providers is make sure to contact everybody in their network who needs the NPI.
“Once one person in the financial chain has the need for an NPI, everyone else in the chain does, too, or it breaks down,” Coppola said.
Providers could find that this reliance on other entities is the hardest aspect of the switch to NPIs. John Heye, vice president of finance at Portland, Maine-based Maine Medical Center (MMC), said, “So far, it seems like the system has been a lot easier.” But despite a smooth signup of all providers in its network, a payer flaw will hurt MMC’s finances in the coming year.
MaineCare, the state’s Medicaid plan to which some procedures at MMC are billed, is not prepared to meet the NPI compliance deadline due to IT failures.
“Their automated system is broken,” said Heye. “Our accounts receivable will go from $70 million to $67 million as that transition happens.”
Payers may experience headaches in coordinating the NPI switch. Paul Hebert, Aetna’s head of provider data services, said Aetna has already had to make a significant number of changes in advance of the compliance deadline.
“The main benefits are on the provider side,” he said. “We have upwards of 1.4 million providers, so we’re trying to be as flexible as possible with them.”
Hebert said the first six months of NPI use will present a number of challenges.
“In line with other HIPAA regulations, everyone won’t march to the same drum starting on May 23,” he said. n