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Government News
Increased Claims Rejections Linked to NPI Mandate
Psychiatric News
Volume 43 Number 14 page 9-10

Health care industry claims processors reported a fourfold increase in the number of rejected Medicare and Medicaid claims on the first day that a new clinician-identification mandate began, but federal officials said the impact on providers has been contained for the time being as they continue to work on fixing the problem.

The Centers for Medicare and Medicaid Services (CMS) began to require health care providers to use the new National Provider Identifier (NPI)—a unique 10-digit number—with all Medicare and Medicaid claims made on or after May 23.

Health care claims processors said before the onset date that the new requirement could result in large numbers of rejections and delayed reimbursements or even a loss by some patients of their access to medical care.

"As an industry, we recognize the need to continue our efforts to comply with the NPI final rule; however, we must balance compliance with the need to ensure business operation continuity, timely reimbursement for services, and patient access to quality care," wrote Nancy Spector, chair of the National Uniform Claim Committee, in an April letter to CMS asking for a delay in the May 23 NPI deadline.

Concerns about disruptions in reimbursement had previously led CMS to postpone the implemention of the NPI requirement on all claims from 2007 to May 23. The new numeric labels, which replaced multiple insurer-provided labels given to health care providers over the years with a single unique tag, were required as part of the paperwork-streamlining provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

After analyzing their data, several health care industry claims-processing organizations reported the jump in rejected Medicare and Medicaid claims after the first day of the new requirement. One claims processor, Emdeon Services, noted in media reports that it had a rejection rate on the day the NPI requirement was implemented of 24 percent for all Medicare plans, worth about $26 million in claims. That compared with an average daily rejection rate before May 23 of 6 percent, or about $11 million.

Most of the rejections were linked to providers using the old numbers to identify secondary providers, according to various media reports.

While CMS found a spike in problematic Medicare claims in the days after the NPI implementation date, most regions had low percentages of providers affected, a CMS official told Psychiatric News. CMS helped resolve many of these reimbursement delays by working with clinicians and other providers to correct their NPI-related problems.

Although the CMS official, who asked not to be identified, said no looming backlog of rejected claims exists, at least one claims-processing contractor, New York-GHI, reported that 22 percent of claims required further clarification because of NPI-related problems in the week after the deadline, according to a June 2 CMS report.

One temporary CMS measure that aims to address problem claims in the first weeks of the new requirement allows providers to use their NPI numbers if they have great difficulty obtaining the NPI numbers for secondary providers.

More information on the NPI is posted at<www.cms.hhs.gov/NationalProvIdentStand/>.

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