Only 100+ days left to NPI kickoff: Are you ready?

February 19, 2007

More than 1.6 million physicians, pharmacists, and healthcare companies have registered for the new National Provider Identifier (NPI) numbers, but experts warn that time is quickly running out. Although the date of the switchover for the Centers for Medicare & Medicaid Services is May 23, officials at CMS and the National Council for Prescription Drug Programs (NCPDP) are urging pharmacists to be prepared by March 1 to ensure a smooth transition. And some payers, such as the state of Delaware, are requiring NPIs even before the May 23 deadline.

The conversion to the NPI has been a long time in coming. The Health Insurance Portability & Accountability Act of 1996 first mandated that CMS begin to use a single number to identify all healthcare providers. It took eight more years to finalize the rules for NPI. Now there are fewer than 100 days left before CMS will accept claims only if they have NPI numbers to identify all healthcare providers (though small health plans are given another year to comply).

In the final days before the changeover, William Rogers, M.D., CMS' chief medical officer and the director of the Physicians Regulatory Issues Team, was very upbeat about the prospect of having a smooth transition. "It's moving along well," he insisted. "We should have everyone enrolled."

In its testimony before a National Committee on Vital & Health Statistics subcommittee, the American Medical Association was equally concerned about whether the system would be up and running by the May 23 deadline. AMA expressed concern that the process was not progressing smoothly and that CMS was not providing adequate guidance.

CMS, AMA, and NCPDP officials all warn that registration is the first step in a long process. Not only do pharmacies need to register for NPI numbers before the deadline, but they must also coordinate with billing services, vendors, and clearinghouses, testing the numbers with payers.

On its Web site, CMS estimated that the testing will take 120 days after a number is obtained, and Graeff is urging pharmacies to provide NCPDP with their NPI numbers as well as those of the physicians they work with by March 1. She warned that numbers submitted after that date may not be included in NCPDP's May database update.

One of the biggest question marks is whether computer systems will be up to the task. Few, if any, software providers developed new programs to handle NPIs, so most have had to develop "crosswalks" to translate NPI numbers into other legacy identifiers. Data warehouse records, rebate information, and payment histories are all tied to different numbers that need to correspond to NPIs following May 23.

One of the reasons for the urgency is that CMS has yet to release its dissemination notice, which Rogers expected to happen "very soon," but could not give an exact date. When it is released, healthcare providers will be able to go to a database to look up NPI numbers for other healthcare providers. "I hoped it would be out a couple of months ago," he admitted. In the meantime, he urged pharmacists to talk with their partners. "The sooner you get the NPI and the sooner you communicate with your associates that need it, the better off you are and the better off they are too," he added.

In the absence of the CMS database, pharmacists and physicians are required to obtain the NPI numbers from their partners, a process that AMA termed "unreasonably burdensome." To facilitate the process, NCPDP is currently developing its own database. According to Graeff, pharmacies and other healthcare companies will be able to use the on-line system to look up NPI or DEA numbers.

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