Whether your mom let you out of cleaning your room, your professor postponed that big exam, the office called to reschedule your colonoscopy or the CMS relaxed your looming compliance deadline, the feeling is the same. Relief, followed by anxiety for what still must be done.
Healthcare leaders of various stripes have welcomed the news that the CMS, in effect, pushed back by up to one year the May 23 deadline to comply with the national provider identifier, or NPI, requirements of the Health Insurance Portability and Accountability Act of 1996.
The reprieve, despite affected parties already having had nearly two years to get ready, came early last week. CMS made the decision to announce this guidance on its enforcement approach after it became apparent that many covered entities would not be able to fully comply with the NPI standard by May 23, 2007, according to a CMS written statement. 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.
The long-delayed NPI has been a requirement under HIPAA from the get-go, but the final rule adopting it was not published until Jan. 23, 2004, and it didnt become effective until May 23, 2005, when the clock finally started on what was supposed to have been a two-year ramp up to implementation.
Despite a healthy amount of participation, enough providers are not up to speed with the program that the CMS decided to give them more time.
According to the latest CMS figures, the pace of enrollment has picked up substantially since last summer. From May 23, 2005, when the enumeration began through March 26 of this year, NPIs have been issued to about 1.5 million individuals and 436,000 organizations, up from a combined estimate of 400,000 as of last June.
Industry experts said their experience supports what those numbers suggestthat most providers, payers and other organizations are onboard. Getting other aspects of the system to work, however, remains a problem. The state of Massachusetts and the Board of (Registration in) Medicine was really proactive and applied for NPIs on behalf of every physician in the state, said John Halamka, the physician chief information officer of the CareGroup Healthcare System, Boston, and Harvard Medical School. You have to ensure all your claim systems can use the new number and the vendors can provide you with patches (computer system upgrades). The problem is some of the payers in our area are still testing.
Most payers and providers in New England got a jump-start on updating their systems, Halamka added.
Nationally, George Arges, senior director of the health data-management group at the American Hospital Association, said most AHA member hospitals have signed up and received their NPIs. We have been surveying our hospitals for this information, and a very high level of our members have an NPI. Its probably around 97%, Arges said. Nevertheless, We welcome the extension, he said.
Its a question of whether theyve been able to test, he said. The other issue for our members is the fact that they need to work with the physicians and identify the physicians as part of this process. The difficulty really is when you have physicians outside of your hospitals and they do referrals and dont have that information readily available. It is a time-consuming process to track down their NPIs. Arges said the AHA made its views known to the CMS about the NPI deadline and pushed for the delay.
George Roman, director of health policy for the American Medical Group Association, said of the extension, I think that two years seems like an inordinately long time, and it is a long time, but this is complex.
Robert Tennant, senior policy adviser for health informatics at the Medical Group Management Association, concurred, adding that rumors are circulating that the CMS will soon issue a second advisory, with a different, possibly shorter, extension for compliance with the NPI provisions for transactions with the Medicare program.