The fast-approaching May 23 deadline for health care providers to use a National Provider Identifier (NPI) — intended to smooth the path toward electronic claims processing — could mean significant decreases in reimbursements for providers.
That is the conclusion of a report from Emdeon Business Services, a Nashville, Tenn.-based health care financial services firm. Emdeon reviewed a sampling of 10 million claims they received during the week of April 28 and analyzed whether the claims would be paid or rejected after the deadline based on the NPI requirement.
Emdeon concluded that a provider NPI was missing in more than 7 percent of professional claims that would therefore not be paid. The firm is a member of the financial systems committee of the Healthcare and Information Management Systems Society.
The report also determined that when identifiers were required for secondary providers — such as pay-to and claim-level-rendering providers — the use of the NPI fell dramatically. Of that group, 29.7 percent did not meet NPI requirements, translating into a claim value of $1,058,082,758, according to the Emdeon report.
When the firm included other claim-level providers and service-level providers, the number of claims that did not meet requirements jumped to 69.3 percent, with a claim value of $2,461,476,030.
“If payers were to strictly require NPI data content for all providers included in claims, these payers could potentially reject 70 percent of claims leading to significant cash flow issues for providers,” Emdeon said in the report.
The NPI requirement is one of the mandates of the Health Insurance Portability and Accountability Act, which stipulated that HIPAA-covered providers must submit claims with an NPI number by May 2007. The Centers for Medicare and Medicaid Services subsequently extended the deadline until May 2008 because so many providers were unprepared for the change.
Since March 1, CMS has required providers to use an NPI number — either alone or paired with a legacy number. But beginning May 23, all claims must be submitted with only an NPI to be eligible for payment. Many providers still have not been able to adequately prepare for the deadline, and that will affect their cash flow.
“I think there is real risk of major disruption to the system that will affect how fast providers can get these claims through,” said Stephanie Rose-Belcher, vice president of payer solutions at Enclarity, an information services company based in Orange County, Calif.
To reduce the likelihood that they will have payment problems later, providers should test their identifier now by submitting claims to all their major payers using only their NPI, according to Rose-Belcher, who has provided her clients with an NPI cheat sheet to aid in preparation.
“I think there is real risk of major disruption to the system,” she said. “The number of providers that don’t have an NPI yet, coupled with inconsistencies on the hospital side, could make this very difficult.”
Government Health IT will present Liesa Jo Jenkins, executive director of CareSpark, in an eSeminar at 11 a.m. Thursday, Oct. 16, where she will share her experiences and insight into building a health information exchange that enhances community health, rewards regional collaboration and drives economic progress.
