2. CMS Adopts Standard Unique Health Identifier under
HIPAA
In the January 23, 2004 Federal Register, the Centers for Medicare and Medicaid Services
(CMS) published the final rule establishing the National Provider Identifier
(NPI) as the standard unique identifier for covered entities as mandated by the
Health Insurance Portability and Accountability Act (HIPAA) of 1996.
Covered entities are defined as health plans,
health-care clearinghouses, and those health-care providers that transmit
electronic health information. The final rule requires all covered entities to
obtain and use NPIs.
The NPI is completely numeric and contains 10 positions
with a check-digit in the last position. It contains no embedded information
about the provider. Once implemented, covered entities will use only the NPI
and it will replace all previous identifiers, e.g., UPIN, Blue Cross and Blue Shield Numbers, CHAMPUS Number,
Medicaid Number. Providers will no longer have to track multiple numbers to
identify themselves in standard transactions with more than one health plan.
The final rule also describes how providers are to
obtain and use NPIs. Providers will be assigned NPIs upon successful completion of an application form,
which can be submitted electronically or on paper. Once an NPI has been
assigned, the provider must furnish updates to any data within 30 days of a
change. CMS is currently developing the National Provider System to process the
applications and updates for NPIs to ensure that each
NPI is unique and to distribute the NPIs.
Although all covered entities under HIPAA must obtain an
NPI, non-covered providers are also eligible.
Covered entities may begin applying for NPIs on May 23, 2005, the effective date for the final
rule. The compliance deadline is May 23, 2007 for all but small health plans.
Small health plans must comply by May 23, 2008.
To read the final rule, “HIPAA Administrative
Simplification: Standard Unique Health Identifier for Health Care Providers,”
visit <http://www.access.gpo.gov/su_docs/fedreg/a040123c.html>.
Scroll to “Health and Human Services Department.”
TReady For New Medicare Coding Requirement?
Laboratories and virtually all other
providers/suppliers have less than one month to comply with a new coding
requirement for their Medicare Part B claims. Only ambulance services are
exempt.
As of this Oct. 1, the claims must contain a valid ICD-9 diagnosis code, with
the service coded to the highest degree of accuracy and specificity. Otherwise,
they will be returned as "unprocessable." The
change applies to both electronic and paper claim formats. The Centers for
Medicare & Medicaid Services says the change is necessary to facilitate
data exchange in accord with HIPAA (the Health Insurance & Portability Act
of 1996). CMS will require test-ordering physicians to provide labs with either
the valid diagnosis code or a narrative diagnosis that labs can use to
determine the appropriate diagnosis code.
Learn what you should be doing right now to get ready for this important policy
change by joining our Sept. 9 audioconference, "How To Comply With New Medicare Coding
Requirements For Lab Claims." The 90-minute session will run from
2-3:30 pm (Eastern).
The audioconference features lab industry experts
Christopher Young, president of Laboratory Management Support Services, and Hyde Frederickson, Compliance
Officer for IHC Laboratory Services.
Registration is just $197 for G-2 newsletter subscribers, $247 for
non-subscribers. Your single paid registration entitles you to as many
listeners per site as you like. Continuing education credit is available. To
register, call 1-800-651-7916 or go online to http://glyphics.quickconf.com/sem-online/ioma.
September 9th Audioconference <http://link.ixs1.net/s/link/click?rc=al&rti=j125532&si=p57027546>
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