The billing provider National Provider Identifier (NPI) is missing in 4.9 percent of institutional claims, and the billing provider and pay-to-provider (when present) is missing in almost 10 percent of such claims, according to an analysis conducted recently by Emdeon Business Services. To determine the extent to which providers’ current submissions comply with standards, Emdeon analyzed 1.9 million institutional claims that it received the week of May 12, 2008.
Among other key findings, the analysis revealed that if payers were to strictly require NPI data content for all providers included in claims, these payers could potentially reject almost 34 percent of claims, leading to significant cash flow issues for hospitals. The findings are troubling, given that all Medicare providers and suppliers are required to use only an NPI as of May 23. Read the overview.
