CMS has extended the May 23 deadline -- with one condition attached -- that had been set for family physicians and all other "covered entities" to begin using their National Provider Identifiers, or NPIs, on health insurance claims.
CMS Softens Stance on NPI Deadline
By Sheri Porter
4/5/2007
In an April 2 press release, CMS Acting Administrator Leslie Norwalk said that covered entities that have shown a "good faith" effort to comply with the NPI provisions will have up to 12 months to implement a contingency plan that could include accepting legacy provider identifiers, also known as Unique Physician Identification Numbers, or UPINs.
The NPI, which was instituted as part of the Health Insurance Portability and Accountability Act of 1996, is a 10-digit, numeric identifier administered by CMS. It is designed to give each health care provider a single, unique identifying number that doesn't change or expire. Physicians not in compliance by the original deadline were facing delays and possible claim rejections.
According to the press release, CMS extended the deadline when it became clear that many covered entities would not meet the original deadline.
"This guidance would protect covered entities from enforcement action if they continue to act in good faith to come into compliance, and they develop and implement contingency plans to enable them and their trading partners to continue to move toward compliance," said the press release.
CMS said contingency plans couldn't extend past May 23, 2008.
As of March 26, more than 1.9 million care providers had acquired NPIs, but many physicians' practice management software systems can't accept the numbers without software upgrades.
Although the deadline extension is good news for family physicians, members should stay on track with their NPI implementation efforts, said Cynthia Hughes, C.P.C., AAFP's coding and compliance specialist.
"Those good faith efforts CMS is looking for may include physicians continuing or initiating a course of action to complete software upgrades and testing with payers; providing their NPI numbers to payers and other physicians or health care providers to whom patients are referred for services; and collecting the NPI numbers of those physicians or other health care providers who refer patients to them for services," said Hughes.
More information on the NPI is available on CMS' Web site (PDF file: 4 pages / 16 KB. More about PDFs) and from the AAFP.
The NPI, which was instituted as part of the Health Insurance Portability and Accountability Act of 1996, is a 10-digit, numeric identifier administered by CMS. It is designed to give each health care provider a single, unique identifying number that doesn't change or expire. Physicians not in compliance by the original deadline were facing delays and possible claim rejections.
According to the press release, CMS extended the deadline when it became clear that many covered entities would not meet the original deadline.
"This guidance would protect covered entities from enforcement action if they continue to act in good faith to come into compliance, and they develop and implement contingency plans to enable them and their trading partners to continue to move toward compliance," said the press release.
CMS said contingency plans couldn't extend past May 23, 2008.
As of March 26, more than 1.9 million care providers had acquired NPIs, but many physicians' practice management software systems can't accept the numbers without software upgrades.
Although the deadline extension is good news for family physicians, members should stay on track with their NPI implementation efforts, said Cynthia Hughes, C.P.C., AAFP's coding and compliance specialist.
"Those good faith efforts CMS is looking for may include physicians continuing or initiating a course of action to complete software upgrades and testing with payers; providing their NPI numbers to payers and other physicians or health care providers to whom patients are referred for services; and collecting the NPI numbers of those physicians or other health care providers who refer patients to them for services," said Hughes.
More information on the NPI is available on CMS' Web site (PDF file: 4 pages / 16 KB. More about PDFs) and from the AAFP.
