Doctors may not be ready for single ID

Washington -- With less than six months to go before most physicians, other health care professionals and payers are expected to be using new ID numbers on claims, a workgroup following the issue has called on the government to allow more time to comply.

Any physician who files claims electronically with any type of public or private payer, even through a separate billing agency, must apply for and start using a 10-digit National Provider Identifier by May 23, 2007. Any doctor who bills Medicare electronically or by paper for services will need to use an NPI by that date or run the risk of delayed or rejected claims, the Centers for Medicare & Medicaid Services has warned.

But a group of health care professionals, insurers, health systems, claims system vendors and data clearinghouses said earlier this month that not all of the necessary pieces would be in place when the deadline arrives. The Workgroup for Electronic Data Interchange, of which the American Medical Association is a corporate member, said CMS must implement a contingency plan that allows the industry to use old ID numbers for at least an additional 12 months beyond the deadline so that all parties are able to replace them with the new identifiers.

WEDI in October surveyed its members and found that many still lacked NPI capabilities and would not gain them until very close to the May deadline. For instance, more than half of those surveyed -- hospitals, drugstores and clinical labs in addition to physicians -- said they would not be ready to start using their ID numbers until after April 1.

Roughly 65% of payers will not be in a position to start accepting the NPI on claims before that date, despite the fact that insurers can request that claimants start using the numbers even before the deadline.

Because all parties need a certain amount of time to test their billing and claims systems with the new identifiers, the revelation that many will have little to no lead-in time has the potential to throw a big wrench in the works, wrote WEDI Chair Mark McLaughlin in a Dec. 5 letter to CMS.

"Our recent discussions with over 200 health care industry experts indicate that the industry is still in the very early stages of implementation and will not be ready to meet the May 23, 2007, deadline," he wrote. "The industry as a whole has also underestimated the complexity and level of work required to implement this national standard."

CMS is partly to blame, McLaughlin said.

The health care community has been handicapped in its upgrade efforts by CMS' failure to release a policy on how personal information associated with the NPI will be accessed and controlled -- something the agency had promised to do by the summer.

Without knowing whether physicians' personal data might be open to discovery by marketing interests or other unauthorized parties, the AMA and others have expressed wariness over embracing the new identifiers right away. At press time, CMS had no update on when it might release the regulations.

Even after the government unveils its data dissemination policy, payers and claimants will need months to make sure their systems can handle the new IDs, according to the workgroup.

Testing the NPI connections between all of the appropriate parties and establishing "crosswalks" of personal data between the old identifiers and the new will be especially time-consuming.

"WEDI's survey respondents are the most informed providers, vendors, clearinghouses and payers in the nation," McLaughlin stated. "We believe if these organizations are behind in their plans, then the rest of the industry may be even further behind."

Keeping up the pressure

CMS appreciates the comment letter from the workgroup and will consider the recommendation for a year-long extension of the deadline as part of its review process, an agency spokesman said. Small insurers already have until May 2008 to become compliant with the NPI system.

In the meantime, federal officials are keeping the pressure on doctors to apply for their identifiers as soon as possible. Citing the possibility that physicians could be denied reimbursement for some claims if they don't act soon enough, CMS has adopted the slogan: "Getting an NPI is free -- not having one can be costly."

The agency said the application process can be accomplished online or by mail and should take a doctor or staff member about 20 minutes to complete. The form will ask the physician to submit certain personal information, such as Social Security numbers, federal employer identification numbers and any other identifiers that the doctor has with Medicare or private insurers.

Once the initial burden of getting an NPI is over, physicians will see how much simpler it is to use one ID number instead of many, CMS says.

The AMA agrees that the identifier could help make life easier for doctors and prepare them for the increasingly paperless world of medical records.

But the Association is keeping the pressure on CMS to make sure that the NPI doesn't also make life easier for those attempting to misuse physician information.

In a Dec. 5 letter to the agency, the latest in a series about the identifier issue, AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, called on CMS to implement an additional safeguard.

A revised Medicare claims form that has been altered to accept NPIs starting in January continues to ask physicians to report their Social Security numbers. The AMA considers this unnecessary and a security risk.

"As Medicare transitions to the National Provider Identifier, there will be an ongoing need to protect and secure the identifying information of patients and physicians," Dr. Maves wrote.

The letter asks CMS to remove immediately the Social Security number requirement from the claims form.