Doctors to get national billing ID numbers

Universal identifiers could cut paperwork, but some experts worry about the government's ability to manage the database.

By Joel B. Finkelstein — Posted Feb. 23, 2004

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Washington -- The move to a one-number-fits-all billing system has begun, but it will be a long time before doctors get to use that national standard in actual transactions.

A new government rule lays out the map toward replacing each physician's myriad billing numbers with one universal identifier that he or she would use to bill all insurers, both public and private. Overall, the final regulation is a positive step toward reducing physicians' paperwork burdens so they can concentrate more on patient care, said AMA Trustee Joseph M. Heyman, MD.

For some, though, enthusiasm for National Provider Identifiers, or NPIs, is tempered by the long road to implementation.

Under the new rule, the Centers for Medicare & Medicaid Services will not begin distributing the 10-digit numbers until May 23, 2005, and use of the NPIs will not officially be required until May 23, 2007.

"A lot of us were shocked to see that ... in the first 16 months, [CMS is] not going to give out any NPIs," said Robert Tennant, the Medical Group Management Assn.'s health informatics expert. "That's the big disappointment." Many physicians' offices currently have several dozen, if not more, billing numbers for all the different insurance plans they accept, he added.

The 16-month window between the rule's release and when the government will start doling out numbers is designed to give CMS the time it needs to create a new database to handle every physician, hospital, health plan and other entity covered under the Health Insurance Portability and Accountability Act. That task will be especially difficult because the database will contain more than just the basic billing data currently used for Medicare transactions.

For example, the database will collect extra background information, such as birth date, state and country of birth, physician taxonomy code and a location address in addition to a mailing address.

But experts were pleased that CMS decided to scale back its plans to collect much more information than just the basic demographic, location and credentialing information needed for the processes to be carried out by the database, which is being called the National Provider System.

"We argued that this should not be seen as an opportunity for the government to collect nonbusiness data," Tennant said. "This number is designed for transactions, not for somebody to find out how many Asian physicians there are in America."

A few nagging concerns

The final rule shows that CMS took many concerns expressed by doctors and others to heart, experts said. For example, in addition to scaling back the scope of the database, the agency decided not to charge physicians for numbers and restricted who has access to database information.

But there are worries, among them that HIPAA history will repeat itself.

Many doctors' offices are still feeling the ripples of the transaction and code set rule that went into effect last year. Anecdotal reports suggest that problems with that change have not fully abated yet. This has caused delays in reimbursement and generated new reasons for claims to be rejected.

And just as with that rule, the government has set a single implementation deadline for all entities that will use the NPIs. That means physicians must wait for software vendors to get their acts together, and software vendors must wait for health plans. If vendors and plans don't choose to get a head start on the deadline, physicians could be left with little or no time to test the new numbers before implementation is in full swing.

Although each physician who participates in Medicare will automatically receive an NPI, all others must apply as of May 23, 2005, for their number. Some experts fear that physicians and others might procrastinate on applying, and that would slow the implementation process.

Another worry is that while CMS decided not to charge physicians for NPI numbers, the agency left open the possibility that it would assess some update or other maintenance fees later to help defray the database's cost.

The National Provider System itself is a cause for concern because its inherent complexity and size suggest it could be unwieldy for an agency that has had difficulty maintaining a billing database just for Medicare.

Some questions persist about who will see the information in the database and how CMS will monitor or restrict that access.

"You wouldn't want marketers getting access to physician information and sending out bulk mailings or something like that," Tennant said.

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NPI timeline

July 1993: The Centers for Medicare & Medicaid Services (known at that time as the Health Care Financing Administration) launches an initiative to develop a universal health care practitioner identification system.

August 1996: Congress passes the Health Insurance Portability and Accountability Act, which includes a mandate to create national unique identifiers.

May 1998: CMS publishes a notice of proposed rule making outlining several possible approaches to developing a national database and practitioner identification system.

January 2004: CMS publishes a final rule on National Provider Identifier numbers.

May 2005: The NPI rule is to go into effect. Physicians can apply and start receiving their numbers.

May 2007: All HIPAA-covered physicians must begin using their NPI numbers for electronic billing and transactions.

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External links

National Provider Identifier final rule, Federal Register, Jan. 23, in pdf (link)

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