Slow down on NPI, providers beg CMS

February 23, 2007

As the ticker on the Medical Economics website indicates, physicians have until May 23 to get a National Provider Identifier (NPI). After that date, Medicare, Medicaid, and larger private payers will require that all claims include the new ID number (Medical Economics, "Get your NPI asap!" Dec. 1, 2006).

As the ticker on the Medical Economics website indicates, physicians have until May 23 to get a National Provider Identifier (NPI). After that date, Medicare, Medicaid, and larger private payers will require that all claims include the new ID number (Medical Economics, "Get your NPI asap!" Dec. 1, 2006).

In recent testimony to the National Committee on Vital and Health Statistics (NCVHS), which advises the government on information technology, the AMA and the Medical Group Management Association (MGMA) asked for an extension of the deadline and criticized the way CMS is implementing the NPI.

Both organizations maintained that the industry will not be ready for the new system by May. To start with, the AMA said, only 1.65 million of the 2.3 million "covered entities," including physicians, have obtained NPIs. Also, the MGMA noted, testing of physician groups with clearinghouses and health plans hadn't begun as of December. And both associations said that many vendors of practice management systems had not supplied needed updates.

The AMA also said physicians were concerned that personal ID information included in NPI applications would not be safeguarded and that NPIs could end up being sold to marketers. Both of these possibilities could increase the danger of identify theft, the AMA added.

Meanwhile, there's a problem with making NPIs available to specialists and others who need referring doctors' numbers to file claims. CMS' delay in deciding on how NPIs will be disseminated to providers has "thwarted the industry's overall ability to prepare for implementation of the NPI and has jeopardized compliance with the May 23, 2007 deadline," said the AMA.

Both associations asked CMS to continue accepting legacy ID numbers after the deadline, with or without NPIs. If CMS doesn't do this, says the AMA, physicians will encounter claims rejections and cash flow interruptions.

A CMS spokesman responds, "We are certainly looking carefully at readiness issues, including all the testimony heard by the NCVHS." But the agency won't have anything more definitive until the NCVHS makes its recommendations and they've been evaluated, the spokesman adds.