We're Ready for National Provider Identifiers! Are You?
If you are a health care provider who bills for services, you probably know about national provider identifiers (NPIs). athenahealth's NPI Workgroup has been working for two years to ensure that all our clients make the transition to NPIs as seamlessly as possible by the May 23, 2007 deadline.
What are NPIs?
NPIs are standard, unique identifying numbers mandated by HIPAA. They are issued to both individuals and organizations who conduct electronic transactions.
There are two types of NPIs:
- Type 1 NPIs are issued to individual providers who keep that number for life. It usually identifies the "Rendering Provider" in a healthcare transaction.
- Type 2 NPIs are issued to organizations. A practice can get as many as it feels are necessary to conduct its business. A practice can get one Type 2 NPI for its entire organization, or it may choose to break its organization up into pieces, or "sub-parts." Examples of sub-parts are labs, rehab units, primary care centers, specialty clinics, or any other organizational unit that operates as its own separate entity for purposes of billing and reimbursement.
How is athenahealth preparing for NPIs?
athenahealth has been preparing for NPIs for two years. We expect to be NPI compliant by the May 23, 2007 deadline.
Our NPI Workgroup includes more than 40 employees working on various aspects of the NPI project. We regularly attend industry conferences and NPI forums, monitor and participate on the Workgroup for Electronic Data Interchange (WEDI) NPI listservs, hold regular NPI meetings and conference calls with the payer community, and conduct internal trainings.
Is the industry ready for NPIs?
In January 2007, WEDI conducted an NPI Industry Readiness Assessment Survey. Even though the sample size was small (n=1,119), the providers, health plans, clearinghouses, and vendors that responded are leaders in the industry. One telling result is the number of respondents who can process "dual strategy" claims.
"Dual strategy" involves sending BOTH the legacy provider number and the NPI on claims. It is the preferred (and sometimes only available) method for testing NPI, allowing payers to test their NPI crosswalk tables and adjudication systems in a production environment. Delays in dual-use adoption delay our available testing time and increase our risk for denials, mispayments, and misrouted remittance. (Note to athenahealth clients: we can send BOTH dual-use claims AND NPI-only claims).
According to the WEDI survey:
- 31% of vendor systems (23) cannot generate an electronic claim with the Billing Provider's NPI and all accompanying data
- 32% of payers (50) cannot currently accept dual strategy claims
NPI is the only allowed identifier on claims as of May 23rd, 2007 according to the NPI Final Rule. Anyone who won't be ready by May 23rd will be non-compliant, and their trading partners may be forced to also be non-compliant (if legacy numbers are required for example) just to continue to get their claims paid.
According to the survey, as of January:
- 41% of vendor systems (31) cannot generate an electronic claim with NPI only
- 85% of payers (132) cannot currently accept NPI only claims
What is athenahealth's role in transitioning to NPIs?
Our role is to ensure that our clients are set up properly and ready to make the May 23rd transition with no interruption in their cash flow. That means we are serving as NPI content experts for our clients, informing clients of NPI deadlines and industry requirements, verifying NPIs entered into athenaNet, understanding payer implementation strategies and timelines, disseminating NPIs to payers, performing payer testing and rollout, and running extensive QA to ensure all goes as planned.
But we depend on our clients to provide accurate NPI data!
How well prepared are athenahealth clients?
athenahealth clients are in the process of getting their NPIs but still have some work to do.
According to athenahealth reports:
- 85% of billable providers have Type-1 NPIs entered into athenaNet
- 61% of clients have completed Type-1 enumeration and entry
- 65% of active medical-groups/departments have Type-2 NPIs in athenaNet
- 54% of clients have completed Type-2 enumeration and entry
What can athenahealth clients do to prepare?
There are a few key actions you must take.
- Get your NPIs! If you still haven't applied, click here.
- Enter your NPIs into athenaNet
- Send us your NPPES welcome letters
- Complete the athenahealth NPI Webinar Evaluation Survey
- Email additional questions to NPI@athenahealth.com
A final note: athenahealth has the tools and expertise to monitor your claims and catch NPI-related issues before they become cash-flow problems. But given the sheer magnitude of the NPI industry transition, most likely there will be errors that evade our scrutiny. Please keep a close eye on your claim payments over the next few months and let us know ASAP if you detect any abnormal denials or claim mispayments so we can research and correct these issues as they arise.