May 23 has come and gone, and national provider identifiers have been used during the course of several billing cycles now. The dust is beginning to settle, enabling providers and payers alike to stand back and assess the transition.
The good news is that the sky did not fall on May 24. Some clearinghouses reported a dramatic spike in rejections immediately following implementation, while others noted that the conversion was relatively smooth. The rejection rate experienced by Navicure clients, for example, remained constant before and after the NPI deadline. This was achieved because clients were forced to use their NPIs before May 23, enabling problems to be identified and corrected before they could have a significant impact on revenue.
Careful planning and comprehensive vendor support resulted in the vast majority of providers being well prepared for the transition. In fact, virtually all the lingering problems can be traced to lack of payer readiness.
While Medicare and most major commercial insurers have reported no problems, a small number of Medicaid plans and local payers have struggled. Some even backed off from using NPI as the sole practice or provider identifier for a time, creating a tug-of-war with providers, who remain unsure about whether to report NPI numbers only, legacy numbers or some mysterious combination of both.
As these glitches are ironed out, however, industry experts also are examining a number of other issues that have arisen since the NPI conversion date.
For example, provider organizations with multiple facilities choosing to consolidate to a single NPI are struggling to determine how to distribute data internally. Because the entity reports under a single NPI, regardless of the number of departments, units or locations, leadership is unsure how to route incoming claims and remittance information accurately and efficiently. Healthcare experts are looking at the possibility of incorporating sub-part NPIs to help provider organizations allocate management, revenue and performance data more easily.
While these nuances are being addressed, forward-thinking revenue cycle management vendors are developing strategies – like assigning facility-specific prefixes with patient account numbers – so that providers have access to the data they need to operate effectively.
Providers that are compliant with NPI requirements are frustrated with colleagues who are running late with their NPI implementation. For example, when one provider refers a patient to another, both NPIs must be reported on the claim. If the consulting provider has not applied for its NPI, the ordering provider cannot supply payers with complete information.
Currently, Medicare has instituted a grace period, where the compliant entity is allowed to use its own NPI without penalty. No one can be sure how long these allowances will be extended, however.
A significant number of payers surprised providers immediately before the NPI implementation date by requiring that 10-character taxonomy codes for the group also be included on claims, in addition to the new NPI number. While the concept of taxonomy codes is not new – they represent and confirm the specialty or subspecialty of reporting providers – the sudden demand to include them at the group level was unexpected.
Payers adopting this tactic defended the requirement by saying it would resolve problems during adjudication because it supplied another layer of definitive identification data. However, providers had to scramble, often with the help of their clearinghouse vendors, to ensure this information appeared in the correct field of the ANSI 837 claim.
There can be no doubt that the relatively uneventful implementation of NPI has been a relief to the entire healthcare community. At the same time, issues that have resulted from the conversion must be addressed in a timely fashion so that the overarching goals of the NPI program can be achieved – without causing delays or disruption in claims’ payment.
Kenneth Bradley is vice president of transaction and interface development for Atlanta-based Navicure, Inc.