CMS blinks, extending NPI deadline for one year

April 13, 2007

Responding to pleas from the health care industry, CMS has extended the deadline for using only a national provider identifier (NPI) on claims forms until May 23, 2008. The original deadline was next month.

Responding to pleas from the health care industry, CMS has extended the deadline for using only a national provider identifier (NPI) on claims forms until May 23, 2008. The original deadline was next month.

As CMS did with the HIPAA electronic transaction set a few years ago, the agency is saying that HIPAA-covered entities, including providers and health plans, must have "contingency plans" to implement the NPI. So, if CMS receives a complaint that an entity is not using the NPI, the entity must show that it has a plan to achieve compliance with the regulation. In the case of physicians and other health-care provider, that means "having obtained an NPI and having the ability to use it on HIPAA transactions." So to be safe, all physicians should obtain their numbers by this May 23 of this year. (To get an NPI, go to www.cms.hhs.gov/NationalProvIdentStand.)

As of February, the AMA said, only 1.65 million of the 2.3 million covered entities had obtained NPIs. Also, few plans or clearinghouses had tested transmission of claims bearing NPIs ("Slow down on NPIs, providers beg CMS," InfoTech Bulletin, Feb. 23). A few months earlier, it appeared that many practices hadn't received practice management software upgrades—or couldn't, because they didn't have support contracts with their vendors ("Get your NPI asap!", Medical Economics, Dec. 1, 2006).

The CMS extension pleased the AMA. "Physicians have worked diligently to prepare for the NPI deadline, but more time is needed for physicians and their business partners to achieve full compliance," AMA Board Chair Cecil B. Wilson, MD, says. "The AMA continues to encourage physicians to obtain their NPI prior to the May 23, 2007 deadline, if they have not already done so."

The MGMA also praised CMS' decision to extend the compliance deadline. But it remains concerned about the agency's failure to publish a data-dissemination policy that would allow providers to obtain the NPIs of other providers they work with. This omission would make it difficult, for example, for specialists to obtain NPIs of referral physicians so they can file claims. According to the MGMA, the lack of a data-dissemination policy is one reason why CMS was forced to postpone its deadline.