Survey: Industry Not Ready for NPI

May 13, 2008

A survey in April of provider organizations, insurers and transactions processing vendors shows an industry woefully unprepared for the May 23 compliance date for the National Provider Identifier. The NPI rule under HIPAA requires that all providers and provider organizations that are HIPAA covered entities obtain a standard identifier to be used for billing and claims processing.

The survey is small, with a total number of 111 respondents. But Healthcare IT Transition Group put it together quickly after hearing many stories that complying with the NPI was “fraught with systemic flaws,” according to the Tulsa, Okla.-based consulting and research firm. “We continued to hear stories from providers who attempted to deploy NPI that their claims went unpaid, sometimes for months, and that their concerns were falling on deaf ears,” according to a report of survey results.

“As hypothesized, the industry’s state of readiness, even in the 11th month of a 12-month contingency period after the initial deadline, is far behind schedule,” the report contends. “The Centers for Medicare and Medicaid Services’ objective to convert to NPI-only processing of electronic transactions by May 23, 2008, is far out of reach.”

Surveyed institutional facilities and billing firms, for instance, reported less than 16% of claims being submitted in April with just the NPI to identify the primary provider, which is required as of May 23.

“It is important to understand that, if Medicare’s announced implementation edits were applied by all health plans, any claim containing a legacy ID in any field would be rejected,” according to the report. “This puts the vast majority of claims (those submitted as ‘dual use’ claims containing both NPI and legacy identifiers, and those submitted with legacy identifiers only) at risk for non-payment on May 23. A single referring, ordering or attending provider whose NPI is unknown, or who has decided not to obtain an NPI, is grounds for rejection of the entire claim under Medicare’s interpretation of the NPI Final Rule.”

Further, insurers are giving conflicting NPI instructions and many claims being pended based on NPI issues “are disappearing altogether,” according to survey respondents.

Healthcare IT Transition Group has released for free a nine-page summary report and the complete report, with recommendations, is available for purchase. More information is available at hittransition.com.

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