PREPARE FOR NATIONAL PROVIDER IDENTIFIER (NPI)

“Getting an NPI is free; not having one is costly,” is the new slogan to get physicians and other providers to apply for the standard identifier as soon as possible.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates the adoption of a standard unique health identifier to replace provider identifiers currently in use with health plans, including Medicare, Medicaid and all other private and public payers. HIPAA-covered physicians and healthcare providers, whether they are individuals or organizations, must obtain an NPI.

When a physician applies for an NPI, he/she must include all legacy identifiers such as PINs, UPINs, Medicaid number, etc. (To apply, go to https://nppes.cms.hhs.gov/NPPES/Welcome.do) However there’s more to the NPI than just applying for a number. Without proper preparations, practices may see a disruption in cash flow next year.

A physician practice must contact all of its health plans to determine the plans’ NPI implementation timeline. The actual compliance deadline is May 23, 2007 (May 23, 2008 for small health plans). For its part, the Centers for Medicare & Medicaid Services (CMS) released its timeline for using the identifier. CMS currently accepts claims with the NPI, but an existing legacy Medicare billing number also must be on the claim, otherwise, Medicare will reject it.

According to CMS’ tips on NPI, a practice must contact its vendors, business associates and colleagues to see if they are ready to deal with the new identifier and when they will begin accepting it. Office staff also must be trained on using the NPI such as: how and when to disseminate it, how to protect it, and when to collect it from other providers for use in HIPAA standard transactions.

In addition, a practice should develop a plan to ensure that the NPI is kept up to date; plus educate staff on how NPIs from other organizations or peers will be collected and validated for use in HIPAA standard referral transactions. Staff must know what to do if another physician’s NPI is needed in a HIPAA standard transaction (i.e., ordered or referred service), but the NPI is unknown.

HIPAA standard transactions include: claims and encounter information, coordination of benefits, claims status inquiries/responses, eligibility inquiries/responses, payment and remittance advices, enrollment/disenrollment in health plans, and referrals.

With less than a year before mandated compliance, CMS plans to hold NPI roundtable discussions via conference calls to help physicians and other providers with the implementation process. CMS suggests that physicians obtain their NPIs at least six months before the compliance deadline to allow time for preparation and testing. NPI products and resources are available through the CMS web site: www.cms.hhs.gov/NationalProvIdentStand/.