STAMFORD, CT – As the deadline to start using national provider identifiers approaches, essential information for implementing the identifiers still hasn’t been released by the government.
As of mid-January, the Centers for Medicare and Meadicaid Services has not released final guidelines for disseminating NPIs, limiting the amount of time available to the industry to test their use in filing claims. The regulation requires the use of NPIs on claims starting May 23, and a lack of testing could produce cash flow problems for providers.
A November report by Gartner Group raised concerns about NPI guidelines that still exist, said its author, Bob Booz, research vice president for the Stamford, Conn.-based consulting firm.
Booz said CMS’ final guidelines for disseminating NPIs have been at least a year in coming.
“Theirs is no complete and sure way to know the provider identification numbers that should be used and no way to ensure compliance,” he said.
The NPI is a 10-digit number used to identify hospitals and physicians. While CMS estimates on its Web site that it will issue nearly 1.6 million numbers, the agency hasn’t released a file of all NPI numbers to payers.
CMS needs to define common data elements and fields in its file. The agency has stopped predicting when it would be able to issue the file, Booz said.
The delay will leave payers with limited time to test the numbers in their claims processing systems. “It creates a tremendous amount of administrative uncertainty around how payers process claims after May 23,” Booz said.
The switch to NPIs will also affect Medicare and Medicaid, because most Medicaid claims and some Medicare claims are processed by private insurance companies, he added.
CMS has not indicated whether it will relax the deadline; NPI regulations specify that Medicare claims will be rejected if they don’t contain the number. The government did show flexibility when it appeared the industry would not be able to widely meet the deadline for using HIPAA standardized transactions.
“Without some relaxation of the deadline or relaxation on enforcement, even if they get … the information, I’m not sure many organizations would be able to become compliant and test transactions before the end of May,” Booz said.
The Gartner report suggests that payers put a solution in place that will enable them to comply with NPI requirements while putting longer-term processes in place for maintaining accurate provider information.
Providers also will face challenges, said Ned Moore, CEO of Portico Systems Inc., a Conshohoken, Pa.-based supplier of an application solution.
“Between now and then, providers have to change their infrastructure to map to the NPIs with all the numbers they’re using now,” Moore said. “If they’re hard-coding, there’s a lot of legacy IDs that they get from the plans. They’ll have to make all those coding changes. Their billing systems are a lot like the payers’ billing systems. Now, they have to touch it, have to untangle it and figure out how to put that NPI number in.”