Medicare NPI - Still Working Through Issues
When the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was passed, it mandated that a unique, shared identification number be issued to healthcare providers.
The Centers for Medicare and Medicaid Services (CMS) began issuing National Provider Identifier (NPI) numbers in October 2006.
There are several legacy healthcare identifiers.
Some of them include:
It has the added benefit of identifying providers on prescriptions, internal files, patient medical record systems and any other standard transaction.
In short, replace all of the other identifiers with a single permanent number.
This number could follow a provider regardless of job or geographical changes.
CMSs original date to force implementation was May 23, 2007.
It subsequently extended that until May 23, 2008.
Even with the extension, it seems CMS is vague about the penalties that may, or may not, be assessed for non-compliance.
NPI is a good idea and, in the long run, it is good for everyone.
Any clinic, or software provider that services them, would rather use one number then navigate the maze of multiple numbers and trying to determine when to use what.
Let us not assume that just because there is only one number everyone is ready to gather around the NPI campfire singing Kum-Ba-Yah.
Not all of the other numbers are being replaced - NPI has just become one more field on the claim.
Every number that was already there is often still required to be there for payment.
While many of these numbers will eventually become obsolete, what motivations do the payors have? Changing the systems to only accommodate NPI is an expensive proposition on both sides.
Providers are not using their NPI - Practice Management software and clearinghouses report that their user communities are requesting features to allow claims from a single location or department to all use the same NPI number.
The software providers see this but they are not exactly the NPI police and are doing what they can to services their clients.
Clearinghouses strip off / add on --Many clinics are seeing their claims go out the door with the NPI on them.
Once the file gets to the clearinghouse, it is removed.
Clearinghouses that are behind schedule in implementing NPI are creating a house of cards for their clients.
Many might be able to replace this with actual NPI functionality, but this becomes a dangerous game, especially when the clinic is thinking they have implemented NPI.
Eventually NPI issues will be resolved and claims will process in a more efficient and expedited manner.
Until we cross that bridge, healthcare clinics that accept Medicare will experience some payment and claim processing delays.
The Centers for Medicare and Medicaid Services (CMS) began issuing National Provider Identifier (NPI) numbers in October 2006.
There are several legacy healthcare identifiers.
Some of them include:
- Online Survey Certification and Reporting (OSCAR)
- National Supplier Clearinghouse (NSC)
- Provider Identification Numbers (PINs)
- Unique Physician Identification Numbers (UPINs)
It has the added benefit of identifying providers on prescriptions, internal files, patient medical record systems and any other standard transaction.
In short, replace all of the other identifiers with a single permanent number.
This number could follow a provider regardless of job or geographical changes.
CMSs original date to force implementation was May 23, 2007.
It subsequently extended that until May 23, 2008.
Even with the extension, it seems CMS is vague about the penalties that may, or may not, be assessed for non-compliance.
NPI is a good idea and, in the long run, it is good for everyone.
Any clinic, or software provider that services them, would rather use one number then navigate the maze of multiple numbers and trying to determine when to use what.
Let us not assume that just because there is only one number everyone is ready to gather around the NPI campfire singing Kum-Ba-Yah.
Not all of the other numbers are being replaced - NPI has just become one more field on the claim.
Every number that was already there is often still required to be there for payment.
While many of these numbers will eventually become obsolete, what motivations do the payors have? Changing the systems to only accommodate NPI is an expensive proposition on both sides.
Providers are not using their NPI - Practice Management software and clearinghouses report that their user communities are requesting features to allow claims from a single location or department to all use the same NPI number.
The software providers see this but they are not exactly the NPI police and are doing what they can to services their clients.
Clearinghouses strip off / add on --Many clinics are seeing their claims go out the door with the NPI on them.
Once the file gets to the clearinghouse, it is removed.
Clearinghouses that are behind schedule in implementing NPI are creating a house of cards for their clients.
Many might be able to replace this with actual NPI functionality, but this becomes a dangerous game, especially when the clinic is thinking they have implemented NPI.
Eventually NPI issues will be resolved and claims will process in a more efficient and expedited manner.
Until we cross that bridge, healthcare clinics that accept Medicare will experience some payment and claim processing delays.
