CMS urges physicians to get national IDs before the rush

Washington -- The Centers for Medicare & Medicaid Services is urging every physician who files claims electronically to obtain a National Provider Identifier well ahead of the deadline, which is less than a year away.

By May 23, 2007, affected physicians must use their unique 10-digit code for all claims activity, not just for Medicare transactions. Some payers might ask doctors to start using the number before the deadline. The NPI, which will not change and which will accompany a physician wherever he or she goes, is mandatory even for doctors who use a separate billing agency to submit electronic claims on their behalf.

CMS says applying for an identifier is a simple, 20-minute procedure that will save physicians much more time and avoid many more headaches in the future. The single number, conceived as part of a federal push for administrative simplification, eventually will replace all other identifiers that doctors use to do business with the government, private payers and clearinghouses. Federal officials hope that by promoting the ID and other electronic standards they will reduce the administrative burden on doctors and convince more of them to give up paper claims for good.

Physicians must submit certain information about themselves when applying for an identifier, which they can accomplish online, by mail or through a designated CMS contractor. Such data include Social Security numbers, federal employer identification numbers and any other identifiers that doctors have with Medicare or private insurers.

Of the roughly 2.3 million physicians, hospitals and other health care entities that need to obtain NPIs, only about 635,000 have done so in the year that the application process has been up and running, according to CMS. The agency is trying to avoid a situation in which too many individuals and organizations wait until the last minute to get on board, overwhelm the system and possibly cause a situation in which private and federal claims are delayed or rejected.

"We're sure that there will be some physicians who on May 23 or later will call up and ask for an NPI," one CMS official said. "That could interfere with continuity of payment, and at the end of the day, continuity of payment is what it's all about."

Security, privacy concerns

Physicians recognize that eliminating all of their other identifiers in favor of one universal number has the potential to make life easier for them, wrote American Medical Association Executive Vice President and CEO Michael D. Maves, MD, MBA, in a recent letter to CMS. But they also want to be sure that improper discovery and use of physicians' personal information doesn't become easier as well, he said.

"As the implementation of the NPI advances toward the May 23, 2007, deadline, concerns over who will have access to the NPIs and how they will be protected will continue to surface," Dr. Maves stated.

Particularly troubling to the AMA is a recent incident in which a theft resulted in the loss of personal information for more than 25 million Dept. of Veterans Affairs beneficiaries. A recent report from the Government Accountability Office also concluded that information security lapses at CMS and the Dept. of Health and Human Services put sensitive information at risk.

The Association is pushing CMS to impose strict limits on how physician data are distributed and who has access to the information. Only entities that have legitimate business transactions with doctors should be able to obtain information related to the NPIs, and implementing such a restriction will require a significant amount of forethought, Dr. Maves wrote.

"The AMA recognizes that a balance must be struck between the needs of physicians and the needs of payers," he stated.

Under no circumstances, however, should details accompanying the identifier be sold or otherwise opened up to companies that would seek to use them for separate commercial purposes, according to the AMA. Some physicians have reported unwelcome attention from marketers who contacted them using Drug Enforcement Administration numbers, which like the NPI are unique identifiers but are open to discovery.

A CMS official said the agency was similarly concerned about security and privacy issues surrounding the rollout of the NPI. He declined to reveal, however, to what extent the agency is considering limiting access to NPI information, saying only that details would come out in a data dissemination policy expected this summer.

The May 2007 deadline still stands, however, and the federal government is urging doctors to sign up for their NPI and to start getting used to using it with their reimbursement requests. Although Medicare began accepting the identifier in January 2006, physicians for the time being also must continue to use any applicable older identifiers until Medicare completes the transition to the new system next year.

Most insurers will be required to accept the NPI alone by May, though smaller health plans will have an additional year to become compliant.