CMS: Comply with NPI

Sunday, April 22, 2007

WASHINGTON - Providers without national provider identification numbers (NPI) risk payment disruption, said Medicare officials during an April 18 conference call.

"The NPI is the standard and the process (for obtaining one) is simple," said a CMS official. "There is very little reason not to have one by May 23."

CMS estimates that about 85% of the more than 2 million providers who need NPIs have obtained them. CMS also estimates that nearly half the industry's health plans and a third of clearinghouses are not ready to use NPIs to process claims; nearly half of software vendors cannot generate claims using NPIs.

"Those are not positive statistics this close to deadline," said a CMS official.

Small health plans have until May 23, 2008, to comply with NPI standards.

CMS on April 2 released guidelines for covered entities, including providers, health plans and clearinghouses, that are not yet NPI-compliant to develop contingency plans and emphasized key points during the call:

* For up to 12 months, through May 23, 2008, CMS will not impose civil money penalties where covered entities are making reasonable and diligent efforts to comply;

* During this period, noncompliant entities must be working toward adoption (of NPI);

* Covered entities can continue using both legacy identifiers and NPIs; and

* CMS will employ a complaint-driven approach to enforce compliance.

"If we receive a complaint, we will ask for documentation and information about what a health plan has done to do testing, and what providers have done to ensure they have an NPI," said a CMS official.

Entities are being encouraged to comply and to terminate contingency plans as soon as possible.

CMS reiterated that the deadline for complying with the NPI remains May 23, 2007.