It is still too early to determine whether the May 23 National Provider Identifier deadline will be troublesome or costly for health care providers, according to a CMS official, Government Health IT reports.
The NPI requirement was mandated under HIPAA to standardize the claims submission system and alleviate some of the confusion related to using multiple identifiers, such as Social Security numbers and other numbers assigned by health plans.
The CMS official said that the agency has not "had any reports of abnormalities or significant problems yet," but added that the "program is still too new for us to draw any firm conclusions" (McKinney, Government Health IT, 5/29).
Spike in Rejected Claims
Health care industry claims processors said they saw a significant increase in rejected claims on May 23, the NPI deadline, Modern Healthcare reports.
Miriam Paramore -- senior vice president of corporate strategy at Emdeon Business Services, a claims clearinghouse and IT service provider -- said Emdeon is seeing a 24% rejection rate for all Medicare claims, which represents about $25.8 million in claims. Prior to the NPI deadline, the average rejection rate for Medicare claims was 6% or $10.6 million, she said.
The rejection rate for Medicaid claims processed by Emdeon on May 23 was 26%, compared with a normal rejection rate of 4%, Paramore said. She added that the rejection rate for Blue Cross and Blue Shield plans claims on May 23 was 6%, up twofold from the normal 3% rejection rate.
Martin Jensen -- chief analyst and chief operating officer of the Healthcare IT Transition Group, a health care consulting firm that has tracked the NPI issue and criticized HHS' plans to go forward with the NPI requirement -- said a state Medicaid official told him that claims flow has dropped from 100,000 claims a day to less than 20,000 (Conn, Modern Healthcare, 5/29).
Reasons for Returned Claims
Some claims still are being submitted with legacy numbers, but those claims will be returned and can be adjusted and resubmitted, according to the CMS official.
The CMS official noted that most of the legacy numbers have appeared in the space for the secondary providers, meaning that the billing provider has an NPI but had trouble obtaining the NPI for another provider.
"If they are having difficulty finding a secondary provider's NPI number, they can access the registry on the CMS Web site or just try to contact that provider," the agency official said, adding, "If neither of those approaches works and they have tried unsuccessfully to find the number, they can use the billing provider's NPI -- which is most often their own - in that space."
CMS said it is working with providers to help them identify the sources of problems, such as incorrect enrollment application data and errors in the National Plan and Provider Enumeration System, which assigns the identification numbers.
More Problems Possible
The CMS official said the extent of problems associated with the NPI deadline will become clearer over the next few weeks (Government Health IT, 5/29).
Paramore noted that because the requirement took effect on a holiday weekend, there could be "some kind of a lag here." She added that it could be days or weeks before the increase in rejected claims becomes a monetary problem for health care providers (Modern Healthcare, 5/29).