NUBC Calls for NPI Delay

The National Uniform Billing Committee has sent a letter to HHS Secretary Michael Leavitt asking for an extension of the Dual Use period, which would allow providers to continue to send both NPI and legacy identifiers for an additional six months.

Waiter? There's a Fly on Your Face
The letter specifically takes CMS's Medicare department to task for actions that "fly in the face of the original intent of the NPI Final Rule."

Which is a polite way of saying that, by telling Providers to get NPIs for each of their legacy Medicare IDs, Medicare contractors and CMS itself (via a stream of communications over the past several years) is violating its own regulations.

The appropriate response, according to NUBC is an extension of the contingency.

We believe a six month extension for dual identifier reporting is needed to allow all trading partners to complete the work necessary to ensure accurate mapping of NPI to legacy numbers and ensure that the Medicare certification process -- including all interfaces to Medicare's Provider Enrollment Chain and Ownership System (PECOS) -- can be updated in a timely manner.

Contingency vs. Coherence
Like I've said before, the issue isn't compliance, it's cash flow. We don't need more contingency so much as a more coherent policy. One that's based on sound pragmatic principles (no, not all providers will have NPIs, and edits that insist upon them will stall claims and penalize providers), adherence to the letter of the regulation (providers get to define themselves, period -- deal with it), anticipation of the problems that will be created if fundamental principles are not adhered to now (providers will need to identify themselves to all payers in the same way, or everything will get worse instead of better) and a truly sensible set of incentives for all (organizations who flout the law will get punished -- at least a public accounting, and perhaps even a nominal fee, please; organizations who attempt to implement in good faith will NOT be punished for it, as so many providers attempting to send NPI-based claims through Medicare's rats nest of a crosswalk have been).

Throwing a Giant Banana to the Gorilla
Delaying enforcement of the rule for six months doesn't mean anything to anyone but Medicare. And so it is, in fact, a necessity. Several Medicaid plans have already faced reality and admitted they will not attempt to enforce strict compliance on May 23 and thus put their patients at risk. Medicare has to pretend they are complying with their own vague, unsubstantiated and often self-contradictory guidance, but they, too, don't want to tick off millions of senior citizens in an election year.

So expect the contingency to be extended, for what that's worth. A few tens of millions of dollars a month in Medicare payments that won't be disrupted is a good thing, I guess, but if we don't fix the fundamental flaws in NPI implementation -- again -- and use the excuse of contingency to push NPI to the back burner, it will again be a really bad mistake. Hopefully the existing and ongoing Medicare payment disruptions will be enough to help providers stay focused.

I trust this won't be the last we hear from NUBC on this issue. This is a necessary step, but not a sufficient one.