WASHINGTON – With the deadline for implementing national provider identifiers about a month away, calls are growing for the government to soften its stance on switching to the numbers on May 23.
The National Committee on Vital and Health Statistics has added its voice to the issue, saying the country’s healthcare system isn’t ready to make the switch.
In a letter to the Department of Health and Human Services in late February, the advisory panel noted that not all providers have acquired the numbers they need, and very little testing of the NPI system has taken place.
There’s concern that the switch could result in disruptions in cash flow, as payers haven’t been able to fully test crosswalks between their legacy systems, which have existing proprietary identifiers for providers, and the new NPI numbers.
“There’s a lot of hope that May 23 won’t be a firm deadline,” said Mark Martin, director of EDI product management for Sage Software, an application vendor which has been trying to prepare users for the rigors of NPI.
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.
Many providers have lagged in applying for NPIs. As of early March, 1.8 million NPIs have been assigned, 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. Nelson said estimates range from 2.7 million to 3 million will eventually be issued.
Questions and uncertainty surround NPIs, he said. For example, some providers have Type 1 NPIs, which is for individual identifiers that go with a person throughout his or her life. Provider organizations need Type 2 NPIs, and some providers who have Type 1 NPIs don’t realize that their larger provider organizations will be required to use a different NPI.
While payers have been working to get providers new NPIs, they don’t have sufficient numbers to test the system, Nelson said. Some payers are asking providers to respond with paper notification of their NPIs. “Some providers are getting hundreds of these,” he said.
While larger practices seem to be well-informed on the changes and disruption that the NPI will cause, many smaller physician practices haven’t grasped the full implications, and that could cause significant disruptions to cash flow, said Sage’s Martin, who hosts the company’s Web seminars on the topic.
“The questions I’m getting are a little scary because we’re so late in the game,” he said. “There will be some cash flow delays, and also, there are pieces of that won’t be delayed but will cause volatility.”
Inaccurate crosswalks will result in increased manual claims adjudication, increased overpayments and increased duplicate claims payments, Nelson said. Payers could also face risks for receiving more customer calls, issuing more duplicate checks and sending payments to sanctioned providers.
Nelson said paper claim forms have been changed to accommodate the NPI. Some physicians mistakenly believe they won’t need an NPI if they don’t file claims electronically, he added.
The government has been silent for several months on when it will release the NPPES data. Nelson theorizes that there are concerns from physicians about privacy.
“It’s supposedly in clearance now,” he said in early March. “CMS was supposed to publish it eight months ago.”
There’s also concern that the system allows anyone who has Internet access to get an NPI. Nelson contends that there are no background checks to ensure that an applicant is a credentialed medical professional.
“All that gets verified is your name with the Social Security Administration. You just have to give your name, Social Security number, date of birth and place of birth,” he said. “Anyone could get an NPI, so this has ramifications for fraud and abuse. When the database is finally released, how good is it really going to be?”