The Centers for Medicare & Medicaid Services (CMS) announced today a contingency plan that extends the compliance date for the National Provider Identifier (NPI) to May 23, 2008 for covered entities that will not meet the May 23, 2007 deadline, but whom are making a “good faith effort” to do so.

You can read the full press release here: CMS Press Release on NPI Contingency Plan.

Basically, CMS is saying that they now realize that many covered entities will not be able to fully comply with the NPI standard by the May 23, 2007 deadline.  So they will not take any enforcement action on non-compliant entities if they can show CMS they are making a “good faith effort” to comply with the standards.  Some of the examples of good faith efforts include:

- For a health care provider, having obtained an NPI and having the ability to use it on HIPAA transactions.

- For a health plan, concerted efforts in advance of the May 23, 2007 deadline and continued efforts afterwards to conduct outreach and make testing opportunities available to its provider community.

- For other “trading partners”, increased external testing with other trading partners.

We don’t think you can interpret this announcement as a blanket extension of the NPI deadline.  Instead, we think CMS is basically saying, hey, let’s not kid ourselves, not everyone is ready for full NPI compliance and we need to give organizations a backup plan who are genuinely doing their best to implement the NPI standard.

We recommend Kareo customers continue at full throttle on their NPI transition.  We are ready for NPI today.  You can enter NPI numbers for practices, providers, service locations, and referring physicians in Kareo.  You can print out the new CMS 1500 form with NPI support.  And just a few weeks ago, we started sending NPIs in all outbound electronic claims.  So we recommend you take advantage of Kareo’s NPI support and make every effort to comply with the original May 23, 2007 deadline.

For more information about the National Provider Identifier (NPI) standards, please visit the Centers for Medicare & Medicaid Services NPI resources page at: http://www.cms.hhs.gov/NationalProvIdentStand/.

A few weeks ago, we started sending National Provider Identifiers (NPIs) in all electronic claims to all payers, provided you have entered your NPIs in Kareo.

There are four areas where you enter NPI numbers in Kareo:

1. Practices – You can setup a group NPI number on the practice record by selecting the menu item Settings > Practice Information.

2. Providers – You can setup a provider NPI number on the provider record by selecting the menu item Settings > Providers.

3. Referring Physicians – You can setup a referring physician NPI number on the referring physician record by selecting the menu item Settings > Other Lists > Find Referring Physicians.

4. Service Locations – You can setup a service location NPI number on the service location record by selecting the menu item Settings > Service Locations.

We have taken every effort to minimize the risk of problems associated with sending NPI numbers in electronic claims.  However, as with any changes in your provider’s insurance claim stream, you may experience problems if your numbers are not setup properly or specific payers have difficulty accepting NPI numbers from Kareo.  You should be extremely vigilant in monitoring the system for rejections and initiating troubleshooting immediately with our customer support team if you notice any problems.

For more information about the National Provider Identifier (NPI) standards, please visit the Centers for Medicare & Medicaid Services NPI resources page at: http://www.cms.hhs.gov/NationalProvIdentStand/.

There are too many numbering schemes in the U.S. to identify healthcare providers.  Most physicians today have a Social Security Number, Employer Identification Number, Drug Enforcement Administration number, State License Number, Medicare Provider Number, Medicaid Provider Number, Blue Cross Provider Number, CHAMPUS Provider Number, State Industrial Accident Provider Number, and on, and on, and on.   Keeping track of all of these numbers causes major problems in healthcare reimbursement.  But that’s about to change.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique identifier for health care providers.  It took nearly 10 years, but the National Provider Identifier (NPI) has finally arrived and the industry is fast preparing for the May 23, 2007 mandatory compliance date.

The NPI numbers are assigned by the Centers for Medicare and Medicaid Services.  The NPI is a numeric 10-digit identifier, consisting of 9 numbers plus a check-digit in the 10th position.  Healthcare providers can get more information at the National Provider Identifier web site or apply online at the National Plan and Provider Enumeration System web site.  Medicare recommends that you apply for an NPI immediately, but no later than November 2006.

There are certain timelines you need to know:

Jan 3, 2006 – Oct 1, 2006 – Medicare will accept claims with an NPI, but an existing legacy Medicare number must also be on the claim.  Medicare will reject, as unprocessable, any claim that includes only an NPI.

Oct 2, 2006 – May 22, 2007 – Medicare will accept an existing legacy Medicare billing number and/or an NPI on claims.  If there is any issue with the provider’s NPI and no Medicare legacy identifier is submitted, the provider may not be paid for the claim.

May 23, 2007 – Forward – Medicare will only accept NPI numbers.  Small health plans have an additional year to be NPI compliant.

Kareo is doing its part to comply with the NPI standards.  You can already setup an NPI as a provider number for a provider in your practice settings.  The NPI will be sent along with electronic claims today.  Also, Kareo will be supporting a new version of the CMS 1500 form designed to support NPI numbers by October 1, 2006.  If you have any questions about Kareo’s support for NPI, you can email support@kareo.com.