NPI deadline: Insurers won't pay claims with old IDs after May 23

Physicians should not count on getting any additional time to become compliant, a CMS official said

By David Glendinning

Washington -- Starting May 23, physicians must use only their National Provider Identifiers in place of any other IDs when filing all electronic claims and some paper claims with Medicare and other payers. The Bush administration already has extended this deadline by a year, but organizations representing doctors and others warn that even more time is needed before they will be ready to make the final transition.

The American Medical Association and the Medical Group Management Assn. are soliciting support from medical specialty societies in asking the administration for a delay on enforcing the deadline. While the vast majority of physicians have NPIs and are using them on claims, most also are still providing their older, "legacy" ID numbers as an interim step toward the new system. The organizations want that step to remain intact for now.

"The AMA is urging Medicare to continue to allow physician practices to submit claims with both the legacy and NPI numbers for at least six more months beyond the May 23 deadline to ensure a smooth transition without disruption in claims processing and payment," said AMA Board of Trustees Chair Edward L. Langston, MD. "The low level of industry readiness and few claims being processed with just an NPI number both point to the need for this extended timeline."

Near the end of April, about 20% of all Medicare claims were being submitted with NPIs only, according to the Centers for Medicare & Medicaid Services. CMS will continue to monitor physicians' progress on the identifier in the days leading up to May 23 and will evaluate if any administrative action on its part is necessary.

But doctors should not count on the agency delaying enforcement of the NPI-only rule. "I don't know that I see a compelling argument there," one official said. "I wouldn't want people to count on having more time at this point."

CMS originally set May 23, 2007, as the compliance date for physicians and other health professionals to adopt the NPI, a 10-digit number designed to replace legacy identifiers on all electronic claims with public and private payers. NPIs also were mandated for paper claims with Medicare and any other payer that required them. But physicians, practice managers and others convinced CMS last year that the industry as a whole needed more time to transition to the new ID system.

So from May 2007 until March 2008, Medicare continued to allow claims to go through even if they contained only older ID numbers. On March 1, carriers started rejecting claims that did not have NPIs but kept approving ones that contained both kinds of identifiers. Now, to take the final step, Medicare is preparing to instruct payers to reject claims that are not NPI-only. Private payers were given the option to implement their own contingency plans as long as they also ended on May 23.

Slow going

The low NPI compliance rate in April prompted the National Uniform Billing Committee and the National Uniform Claim Committee -- which work to create claims standards for both institutional and noninstitutional health care entities -- to ask the administration for more time to complete the switch to the NPI. The AMA and MGMA soon followed suit.

Many physicians could be holding off on dropping their legacy identifiers from claims because they are concerned about continuing problems that Medicare and other payers are having with transferring personal information from the old ID systems to the new one, said Nancy W. Spector, the AMA's director of electronic medical systems and the NUCC's chair. Doctors are worried that they will run into a cash-flow problem when they go NPI-only and start seeing claims rejected because their data don't match between the two systems.

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