Nearly one in five of the health care providers in the United States have failed to obtain a new identification number from the Centers for Medicare and Medicaid Services, although the deadline for using the so-called National Provider Identifier (NPI) is less than two months away.
Even those who have obtained the new ID numbers are not always giving their new numbers to their business associates and ensuring that the numbers are entered into payment and claims databases, according to experts who testified before the National Committee on Vital and Health Statistics (NCVHS) earlier this year.
The results could include doctors going unpaid and prescriptions going unfilled, the NCVHS chairman, Dr. Simon Cohn, said in a letter to Health and Human Services Secretary Mike Leavitt.
“All [the witnesses] expressed a great degree of concern, and agreed that many in the industry will not be able to meet the May 23, 2007, compliance date,” the letter said.
The National Provider Identifier is intended to replace the jumble of IDs many health care providers have been required to use until now. They may have different ID numbers for participating in their state’s Medicaid program, for various private insurance companies that cover their patients and for Medicare.
In the Health Insurance Portability and Accountability Act of 1996, Congress mandated a single new ID number that would be used in all health care transactions. CMS began issuing the new 10-digit numbers in 2005, but their use is not yet mandatory.
Given the failure of doctors and other health care providers to obtain and use the numbers, Cohn’s letter said, “we are convinced that requiring complete compliance with the NPI standard on May 23, 2007, is unrealistic.” The committee recommended that CMS issue guidelines for transitioning gradually over a six-month period.
Part of the problem is that health plans, claims clearinghouses and others involved in getting doctors paid and claims processed must build crosswalks to make the transition from their legacy ID numbers to the new ones. They also must test data transfers between systems --- for example, from a hospital to an insurer --- to ensure that the new numbers won’t cause breakdowns and errors.
Since last year, NCVHS has been urging HHS to make available data from CMS’ National Plan/Provider Enumeration System so that payers and others can obtain the NPIs of their business associates and validate those they already have obtained.
CMS spokesman Aaron Hase said today the agency is working on a legal notice about making the data available, but he would not provide any specifics. The legal notice has been under review in HHS at least since last September, when CMS officials held a teleconference on NPI.
About 2.3 million health care providers are believed to need the numbers. As of today, 1.9 million numbers had been issued.
