Home Health & Hospice Week

CMS promises 'guidance' by deadline.

Heads up: There are just about two months left until the May 23 deadline to start using National Provider Identifiers--and the new system isn't quite ready for prime time. Problem #1: Most providers still haven't tested out billing with an NPI, Centers for Medicare & Medicaid Services officials told the March 5 meeting of the Practicing Physicians Advisory Council. By now, 80 percent of known providers have obtained an NPI, but only 20 percent are "actively implementing" the numbers in billing, CMS said.

This means most providers need to get with the NPI billing program within the next month, or risk delays in payment, CMS officials noted. Problem #2: CMS still hasn't explained how you're going to get the NPIs for doctors and other providers with whom you do business. Starting May 23, you'll have to list the NPIs for doctors who refer patients to you--or expect denials.

CMS has been promising for years to issue a "Data Dissemination Notice" that would explain how to obtain the NPIs of other health care providers. But CMS has been dragging its feet and stonewalling, provider advocates complain. As far back as April 2006, the Workgroup for Electronic Data Interchange (WEDI) warned that any further delays in the publication of this notice would endanger providers' ability to meet the May 2007 deadline.

CMS finally sent this all-important notice to the Office of Management and Budget for clearance on Feb. 26, says Martin Jensen, a consultant with Healthcare IT Transition in Tulsa, OK. Once the OMB approves the Notice, it can appear in the Federal Register. But the OMB could take up to 90 days to approve it--until late May.

Broken record: When callers to the March 6 physician Open Door Forum asked questions about NPIs, CMS officials answered that the delayed Data Dissemination Notice would explain everything. One caller demanded to know how billers should handle referrals from doctors who haven't yet obtained an NPI, and CMS referred her to the Notice.

Home care providers hope to receive more information about the problem in the upcoming March 14 home health Open Door Forum.

For now, the only way to obtain the NPIs of doctors you do business with is to contact them one by one, CMS officials said in the physician forum. But they promised that this confusion won't keep you from getting paid. "We'll have guidance out there that will enable something to be put into that [referring physician] field so that your claims can get processed," one official promised.

 Privacy conundrum: The problem with setting up an NPI-sharing database is that NPI data includes a physician's home address and social security number, explains Jensen. So doctors fear identity theft or more [...]