HFMA NEWS

Despite requests that it consider delaying the enforcement of the May 23, 2008, National Provider Identifier (NPI) deadline, the Centers for Medicare and Medicaid Services (CMS) reminded all Medicare providers and suppliers that as of that date, they are required to use only an NPI to identify healthcare providers in all Health Insurance Portability and Accountability Act (HIPAA) standard transactions used in the Medicare fee-for-service program.

The final rule adopting the NPI as the standard unique health identifier for healthcare providers was published Jan. 23, 2004, and became effective on May 23, 2005. All HIPAA-covered entities had to be in compliance with NPI provisions by May 23, 2007, except for small health plans, which were given an extra year. As of last Friday, all healthcare providers and suppliers who submit claims to Medicare contractors (fiscal intermediaries, carriers, A/B Medicare administrative contractors (MACs), and durable medical equipment MACs) must use their NPIs to identify themselves and any other healthcare providers and suppliers on those claims. If a standard transaction is sent to Medicare with a Medicare legacy identifier in any of the provider fields, the transaction will be rejected. Read the press release.

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.