Suggested Content
- Community Care Newsbriefs
- AMA wants longer ICD-10 delay
- Research finds readmission rates linked to availability of care, socioeconomics
- OIG pressures CMS on home health sanctions
- Skilled nursing facilities face $782M in cuts under sequester
- HHS reduces unnecessary burden on healthcare providers, saves nearly $1.1B
- HHS to provide $11B to help states raise primary care Medicaid reimbursements
- RUC analysis attempts to shift debate
May 23 has come and gone, and national provider identifiers have been used during the course of several billing cycles now. The dust is beginning to settle, enabling providers and payers alike to stand back and assess the transition.
The good news is that the sky did not fall on May 24. Some clearinghouses reported a dramatic spike in rejections immediately following implementation, while others noted that the conversion was relatively smooth. The rejection rate experienced by Navicure clients, for example, remained constant before and after the NPI deadline. This was achieved because clients were forced to use their NPIs before May 23, enabling problems to be identified and corrected before they could have a significant impact on revenue.
Careful planning and comprehensive vendor support resulted in the vast majority of providers being well prepared for the transition. In fact, virtually all the lingering problems can be traced to lack of payer readiness.
While Medicare and most major commercial insurers have reported no problems, a small number of Medicaid plans and local payers have struggled. Some even backed off from using NPI as the sole practice or provider identifier for a time, creating a tug-of-war with providers, who remain unsure about whether to report NPI numbers only, legacy numbers or some mysterious combination of both.
As these glitches are ironed out, however, industry experts also are examining a number of other issues that have arisen since the NPI conversion date.
For example, provider organizations with multiple facilities choosing to consolidate to a single NPI are struggling to determine how to distribute data internally. Because the entity reports under a single NPI, regardless of the number of departments, units or locations, leadership is unsure how to route incoming claims and remittance information accurately and efficiently. Healthcare experts are looking at the possibility of incorporating sub-part NPIs to help provider organizations allocate management, revenue and performance data more easily.
