Ann & Natalie’s Compliance Corner
Welcome back to Ann & Natalie’s Compliance Corner! This month, we report on the Centers for Medicare and Medicaid (CMS) National Provider Identification (NPI) contingency plan. Missed last month’s update on requirements of the Deficit Reduction Act (DRA) that may affect your practice? Click here.
On April 2, 2007, CMS announced that it is implementing a contingency plan for covered entities, excluding small health plans, who will not meet the May 23, 2007 deadline for complying with the National Provider Identification (NPI) regulations under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
The adoption of NPIs (which are standard, unique health identifiers) is mandated by HIPAA. The NPI will replace all “legacy” identifiers currently in use, including: Medicaid Provider IDs, individual plan provider IDs, and UPINs. NPIs will be required for use on health care claims and when conducting other HIPAA-governed transactions. Use of the NPI is intended to lower costs and improve efficiency in the healthcare system by eliminating the need for providers to maintain multiple identification numbers assigned by the various health plans they bill.
The final rule that established the NPI as the standard unique health provider identifier for healthcare providers was published in 2004 and requires all covered entities to comply with its provisions by May 23, 2007 (except for small health plans, which have a May 23, 2008 deadline to comply).
However, the agency decided to soften its enforcement approach “after it became apparent that many covered entities would not be able to fully comply with the NPI standards by May 23, 2007,” according to a CMS press release.
The CMS enforcement process is complaint-driven, and permits covered entities to demonstrate good faith efforts and to employ contingency plans. If a complaint is lodged, CMS said that a covered entity will not be subject to enforcement action for up to one year after the original compliance deadline when it has made a good faith effort to comply with the NPI standards and to implement contingency plans to move toward compliance.
“If a complaint is filed against a covered entity, CMS will... not impose penalties on covered entities that have deployed contingencies to ensure the smooth flow of payment continues,” the agency added.
Medicare will continue accepting legacy-number-only claims for an unspecified period of time. The length of the legacy-only period depends on how many providers begin submitting claims using NPI and legacy or using only their NPIs. However, after May 23, 2008, legacy numbers will not be permitted on any Medicare transaction.
Contingency plans may not extend beyond May 23, 2008, CMS said, but entities may elect to end their own contingency plans sooner.
To read the CMS press release, click here.
To read the contingency plan guidance on the CMS website, click here.
Disclaimer: The content of Compliance Corner is for general informational purposes only and should not be interpreted as compliance guidance or advice. Consult your compliance advisor or attorney for compliance or legal advice on specific issues related to your practice or compliance program.
