NEWS & TRENDS
Fam Pract Manag. 2005 May;14(5):15.
- CMS flexible on May 23 NPI deadline
- Survey: 1 in 10 children have used retail clinics
- Health Plan Contracts: Colorado governor signs health plan contract bill
CMS flexible on May 23 NPI deadline
The Centers for Medicare & Medicaid Services (CMS) has announced an extension of up to 12 months for physicians and certain “covered entities” who are unable to meet the May 23 deadline to begin using the new National Provider Identifier (NPI).
There is one condition: The extension can be used only by covered entities that have made “a good faith effort” to comply with the NPI provisions, according to the CMS announcement. I you meet that condition, you may implement a contingency plan for up to 12 months, including using legacy provider numbers, also known as Unique Physician Identification Numbers (UPIN).
For physicians, good faith efforts may include obtaining an NPI number, providing it to payers, working with payers to complete needed testing and pursuing software upgrades required to accommodate the NPI.
Survey: 1 in 10 children have used retail clinics
A perhaps surprisingly high number of children have already visited a retail health clinic, and many of them will return in the future if their parents have anything to say about it, according to a recent survey conducted for C.S. Mott Children's Hospital in Ann Arbor, Mich.
The March survey of more than 2,000 adults found that 10 percent of children have been to a retail health clinic, and 15 percent of children are likely or very likely to visit one in the future. Among adults, the percentages are even higher: 11 percent had been to a retail clinic and 19 percent are likely or very likely to use one in the future.
Of those parents who had taken their children to a retail clinic, 28 percent said they were very likely and 42 percent said they were likely to use a retail clinic in the future.
The survey also found that 53 percent of the children's retail-clinic visits were covered in full by insurance. Twenty-two percent were paid out-of-pocket by parents.
The American Academy of Pediatrics recently adopted a policy statement opposing retail clinics because they do not support the “medical home” model.
Health Plan Contracts: Colorado governor signs health plan contract bill
With dozens of physicians watching, a Colorado bill (SB 79) to make health plan contracts more transparent was signed in to law by the governor in March. The state's outgoing governor vetoed similar legislation last year.
“The bill lets doctors actually see what they're going to get paid, why they're getting paid that amount and what was used to calculate the fees,” Larry Kipe, MD, president of the Colorado AFP, told AAFP News Now.
The new law will require health plans to disclose all the information necessary for a physician to make an informed business decision, such as fee schedules. It will prohibit unfair contracting provisions, such as a health plan unilaterally amending a contract without prior notification or negotiation with the physician. It will also require third parties who rent a health plan's provider network to abide by all terms of the contract in order to enforce a discounted fee schedule.
Copyright © 2005 by the American Academy of Family Physicians.
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