February 2007 Newsletter
NPI: A Complex "Simplification"
"Administrative Simplification” was the predominant rallying phrase of what we generally refer to as HIPAA. A noble concept in principle, the realities of the decisions being made and policies implemented tell a whole different tale.
With the last two releases of Xpeditor (v 3.7 & v 3.8), Quadax made a command decision to begin displaying Professional claims as the new CMS-1500 and Institutional claims as the new UB-04. Apprehension was the all-encompassing adjective used to describe client and employee concerns over how these new "forms” would impact workflow.
The 1500 did not cause much of a blip in terms of product support, primarily because the major changes were some new fields added to display the National Provider Identifier (NPI) and four "extra” diagnosis codes.
The UB-04 was a different animal, but the eventual impact was negligible, and we can all begin to move forward and deal with some of the other "simplifications” facing us.
NPI is probably the most significant of these matters, and while we are all being bombarded with notices from payers, our experience has been that the effort to acquire these new numbers is not first and foremost in the plans of our provider clients. This, of course, will change as the May 23rd deadline draws closer and anxiety increases.
NPI can be considered the most complex of all the "simplifications.” In our contacts with clients, most conversations revolve around the facility’s, or contracted provider’s, NPI(s) and how they will be reported. Which payers are ready to accept them? What about the ones that seem to be implementing it as a requirement ahead of the dates? How will we be informed of the specific ramifications associated with each payer?
An even greater concern, only now getting the attention, is what payers will accept or require for referring, attending, and operating physicians. Theoretically, NPI simplifies this area because it will no longer be necessary to maintain lists of UPINs, Medicaid numbers, State License numbers, etc. But, unlike those numbers, there is no repository that can be accessed to identify them. Clients are wondering if Quadax will “open our database” to them, or if CMS will provide a Web site.
At present, we have few, if any, concrete answers to these questions. However, you will be kept apprised of every development we become aware of through the various reporting means we make available to all of our clients. Our Client Access and Notification System (CANS), Q-Tips and Connections newsletters, and a growing list of white papers, coined Policies in Practice, are all forms of Quadax reporting.
The most recent white paper explains the contradiction between the ANSI 837P format’s allowance for up to eight diagnosis codes on a claim vs. the new CMS-1500’s display of four, along with the limitation of only four pointers per charge line and how Xpeditor accommodates these nuances. Click here to read the entire paper.