NPI Delays: News Travels Half-Fast

We seem to remember saying something about Medicare NPI SNAFUs leaving providers unpaid sometime back (see Medicare: Expect Claims to Hang In Limbo for Months), but I guess it takes a real reporter to make news.

Good thing we have some -- like E.B. Solomont of the NY Sun. His article today, Glitch by the U.S. Government Is Delaying Medicare Payments, sheds light on the real problem with Medicare's double-blind NPI remediation (they won't publish their crosswalk, and they won't update provider enrollments even after they tell billers that claims are bouncing for unmatched fields).

Solomont gets the human side of the story. The Bronx doc who is borrowing from her kids' savings account to make up for a $20,000 Medicare backlog. The Queens MD with 200 unpaid claims, who's been working for free all year while his business runs on fumes.

Medicare's response is classic:

Yesterday, CMS officials said the agency was "very sensitive to any provider that's getting a claim rejected," but they said the number of rejected claims was small. "They've been given a lot of notice before we started rejecting claims," an agency spokesman said.

Sensitivity is great, but let's peel back the onion in those statements and see if we can work up some real live tears.

Size Does Matter
First, what does "small" mean to Medicare? Let's say that 1% is a small number. Based on the number of claims they processed in 2006 (the most recent year for which statistics are available), that would be just a hair (if your hair is 300,000 claims wide) over 11 million claims. That's less than a million claims a month!

And maybe "small" is a fraction of a percent.

Or maybe it's a couple percent. "Small" is not a number people who know the number use if the number really is small.

How Does It Feel to Be One of the Few, the Plowed?
Admittedly that problem really is tiny at the Medicare end -- at least when you compare it to what happens at the provider end. Because for a provider whose NPI crosswalk is failing, the number of rejects can jump to 100% of Medicare payments. And even for a provider who is getting some of the claims through, a crosswalk failure usually means that claims from a particular source (say a hospital's outpatient surgery unit) will fail at that consistent 100% rate.

Resistance Is Futile
Okay, what about that "notice" that providers are getting? A lot of times, those instructions will tell the provider that they need to update one of two records -- or perhaps both. One of those is their NPPES record: the NPI data itself. Maybe they need to add their legacy Medicare number (OSCAR, UPIN, PIN, whatever) as an "Other Identifier." Maybe they need to correct a typo in their business name. Okay, great. Most providers created those records themselves, and can go and fix many (not all) of those problems online.

Compliance, However, is Futile, Too
The sticky wicket is when the "notification" says the problem lies in their Medicare enrollment data.  That's a long and complicated application based on their 855 enrollment forms. The record is contained in Medicares PECOS system. And, guess what? Providers can't change what's in it -- they have to fill out a new paper form (with zero errors, if you please!), submit it to their Medicare contractor and wait.

And wait.

And wait.

While they are waiting, those notifications have been turning into rejections. Callers on a recent Medicare Roundtable complained that their submitted enrollment changes have been in limbo for months. The carriers are unresponsive, the claims are not getting paid, and the provider is helpless to do anything about it. Medicare claims to be prioritizing such updates, which seems to mean telling carriers how unhappy providers are getting.

Plans To Hasten Resolution Are In Process -- Please Hold
They also have an announced, but less than detailed, plan to give providers access to their own PECOS record. Problem is, no availabilty date has been set and -- you guessed it -- there's a long paper form that needs to be filled out in advance.

HITTG Hits Back
We've gotten kind of tired of seeing the bad things that are about to happen, telling people about them, watching them happen anyway, and waiting weeks or months for awareness to finally dawn, that we've decided to take matters into our own hands.

So, for instance, when we warned you about one of the next big provider-hostile, claim-bouncing SNAFUs Medicare has in store -- the kluge they devised to compensate for their own misunderstanding of the NPI rule regarding un-enumerated practitioners -- we discreetly moved to put a stop to it before it happened.

Freedom's Just Another Word
So far, that effort is going well. And it best be kept under wraps lest the gorillas send their thugs out to stop the process we set into motion (we're actually pretty sure they know, but we're hopeful they sent bonobos to make nice). We just came to realize that our puny little company has a lot less to lose than any of the physicians, labs, clinics or hospitals who will be affected by the logjam Medicare has planned for May 23. They don't see it coming, and we do.

But even if they did, they can't afford to raise a ruckus with CMS. And we can.

You're Probably Wondering, "But Marty, How Can I Help?"
We don't have much to lose, but we really have nothing to gain, either. There's not a lot of money in pro-active disaster avoidance. We make our living selling our webinars, videos, grant resource directories and publications. If you want us to keep at our feisty work, look for something on that list and buy it. (You can also buy something just because our independent analysis is worth a whole lot more than you pay for it -- and way, way more than most of the stuff that axe-grinding vendors and politically-sensitive associations give away for free.)

Or hire us to help you with NPI or any of our other areas of expertise. Operators are standing by.

Thanks.

Comments

[Dr. P (Name withheld by request)]

First time to your blog. Right on the money--or lack of money. Since september 2007 my medicare reimbursements have essentially stopped. Since february 2008 I have over $110k in claims submissions to Medicare, I've been borrowing money to keep my practice going. My IRA's are next. It's hard to complain. Who's going to listen your patients? Then you'll just look like a greedy doctor. My NPI is improperly linked to the wrong place of service by what they admit is their problem with the system. Apparently they never accounted for docs that work from more than one location. I got home from work the other day while the sun was still up and my 9 year old acted like it was Christmas. I've got a 1982 corvette for sale runs great needs interior restoration--$6000.00.