Doctors and healthcare executives could lose money if they don't take advantage of the year-long National Provider Identifier rule contingency period to get things up and running, according to Martin Jensen, COO and chief analyst of Tulsa, Okla.-based Healthcare IT Transition Group.
"People are not understanding that the contingency is a process, not an event," said Jensen, who serves as co-chair of two sub-workgroups for the Workgroup for Electronic Data Interchange (WEDI). The contingency period allows time to work things out with vendors and make sure the system works, Jensen said.
Jensen hosts Webinars on preparing for NPI. He said as soon as the Centers for Medicare & Medicaid Services (CMS) announced the one-year contingency in May, interest in his trainings dropped off dramatically.
Without preparation, healthcare executives may not be able to track revenue after NPI kicks in, claims could be unidentifiable by health plans and they may have to be manually processed, Jensen predicts.
Jensen warns that some payers will find their arbitrary ways will not work under the new NPI system. In essence, the rug will be pulled out from under them. The traditional approach has been that certain payers have been assigning numbers and then requiring that providers send different IDs for different circumstances, Jensen said. "With NPI, that goes away."
According to CMS, until May 23, 2008 it will not impose penalties on providers that deploy contingency plans to ensure the smooth flow of payments if they have made reasonable and diligent efforts to become compliant.
Yet providers can't look to CMS for answers, according to WEDI, which issued a paper May 23 on how to enact a transition plan.
"CMS does not provide specific steps, milestones or guidance on how to implement an NPI transition during the contingency period so that compliance can be achieved progressively, in an orderly, efficient and cost-effective manner," WEDI said.
What happens after May 23, 2008? According to WEDI:
• Covered entities MUST be fully compliant with regulations
• Covered entities will NOT be able to continue to use documented good faith
efforts to justify continued non-compliance with regulations.
Jensen said the main barrier to preparation is provider awareness and getting physician buy-in.
"Doctors see NPI as a threat and a curse, when it's actually meant to make their life easier," Jensen said.