NPI Enforcement Delay No Excuse for Procrastination
[Posted 04/05/07]

Recognizing a low level of NPI readiness in the health care industry, the Centers for Medicare & Medicaid Services Tuesday announced that it would allow Medicare carriers and other payors to continue accepting legacy provider identification numbers until May 23, 2008. Payors can take advantage ofthis one-year grace period as long as they have a contingency plan in place and are able to demonstrate “good faith efforts” to comply with the regulations.

This does not, however, mean that physicians who don’t yet have their NPIs can continue to procrastinate. Medicare and other payors may at any time after May 23, 2007, decide to stop accepting legacy numbers and to only accept the new NPIs. To avoid disruptions in cash flow, physicians should make sure that they have their NPIs no later than May 23, and have registered them with all payors.

Physicians are required by the Health Insurance Portability and Accountability Act (HIPAA) to get NPIs, which will replace UPINs and other payor-specific provider identification numbers on standard electronic health care transactions.

Applying for an NPI is fairly simple. Physicians can apply online at https://nppes.cms.hhs.gov. If you do not have Internet access, call the NPI Enumerator at 800/465-3203 and request a paper application form.

CMA’s legal department has also written a primer to help physicians with the NPI process. The primer, available through the CMA ON-CALL system, is available free to members at the members-only website. See document #1608, “National Provider Identifiers.” Nonmembers can purchase ON-CALL documents for $2 per page in the CMA bookstore.

While applying for an NPI is straightforward, making sure your billing systems and vendors are ready for the transition is a more complicated process, one that requires some preparation and internal assessment. CMA’s HIPAA partner, PrivaPlan, has developed an inexpensive CD-ROM toolkit to help physicians navigate the process.

If you haven’t investigated it, you should give it a look. The toolkit will help physicians understand their NPI “readiness” and the impact the NPI may have on their practices. It also provides form letters and surveys to send to your major system vendors, clearinghouses, and health plans, to determine their NPI readiness.

CMA members can purchase the toolkit for $99. CMA members who have purchased PrivaPlan’s other HIPAA toolkits pay $79. Nonmembers pay $129. Order the toolkit by calling 877/218-7707.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.