WASHINGTON – Providers and payers making a good-faith effort to implement the national provider identifier will have as much as 12 more months to start using the identifiers on claim forms. The delay in enforcing a May 23 deadline gives the healthcare industry much-needed breathing room to ensure that all providers have numbers and that identifiers can be fully tested by providers, payers and other healthcare entities.
The NPI regulations fall under the Health Insurance Portability and Accountability Act, which had set a May 23, 2007 deadline for implementing the identifiers. Under the new guidelines, healthcare entities will have an extra 12 months, during which time they can continue to use legacy identifiers.
“Entities that have made a good-faith effort to comply with the NPI provisions may implement contingency plans that could include accepting legacy provider numbers on HIPAA transactions in order to maintain operations and cash flows,” said CMS Acting Administrator Leslie V. Norwalk.
The delay in implementing in NPIs, given the circumstances, was almost inevitable, said Michael L. Nelson, director of business development for Health Market Science, a King of Prussia, Pa.-based company that is offering NPI services and applications.
“I didn’t see how (the delay) couldn’t happen,” he said. “I was pleasantly surprised that they made it 12 months.”
The agency said it made its decision after it became apparent that many covered entities would not be able to fully comply with the NPI standard by May 23.
“HHS recognizes that transactions often require the participation of two covered entities and that noncompliance by one covered entity may put the second covered entity in a difficult position,” HHS officials said in a press release announcing the delay.
CMS said its enforcement process will be “complaint-driven” and will allow covered entities “to demonstrate good-faith efforts to employ contingency plans,” the agency announced. Entities can end their contingency plans sooner, and Medicare will announce its own contingency plans soon.
Back in 2003, the federal agency issued contingency plans when it appeared that the healthcare industry was not ready to make the switch to HIPAA-standardized transactions. That grace period remained in effect for several months while CMS continued to measure the percentage of HIPAA-compliant EDI transactions.
The delay also takes pressure off the federal government, which has faced increasing industry pressure because of the lack of information regarding the transition. A significant issue in testing NPIs is that the government, as of mid-March, has yet to release data in the National Plan and Provider Enumeration System, which would provide a central resource for looking up provider identifiers.
Nelson said it’s possible that the release of NPPES data could be published in the Federal Register at the end of May. The industry would then have 30 days to comment on the regulation; those comments would be taken as advisement before the final regulations were released.
Nelson said privacy and confidentiality concerns appear to have delayed publication of the initial NPPES guidance.Many providers have lagged in applying for NPIs. As of early March, 1.8 million NPIs have been assigned, said Nelson. He said estimates range from 2.7 million to 3 million NPIs will eventually be issued.The government will push for quick adoption of NPIs, but its ability to prod the industry may be limited, Nelson said.
“How many people does the government have that are going to be enforcing it?” he said.