http://blog.hittransition.com/ Analysis and perspective on standards development, policy, implementation and funding in Healthcare IT from Marty Jensen and Michael Christopher of HITTG. en-US 2008-07-16T11:41:09-05:00 http://feeds.feedburner.com/~r/hittransition/NIxI/~3/337237911/july-grant-roun.html Listing of recent grants for healthcare technology... EHR - Electronic Health Records Grants and Funding RHIO - Regional Health Information Organization Rural Healthcare Michael Christopher 2008-07-16T11:41:09-05:00 http://blog.hittransition.com/2008/07/july-grant-roun.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/335447046/new-hipaa-stand.html Tired of the ambiguities and outdated constraints of the electronic claim, remittance advice, eligibility and other X12 transactions? Help is on the way. Or at least it's coming into view. The enabling regulation to adopt a new version of those standards has cleared the Department of Health and Human Services and has been passed on to Office of Management and Budget for final review. OMB has 30 days to approve it (with or without revisions negotiated with HHS) or reject it. I was fortunate to have the opportunity to participate in some of the X12 workgroups that built the new standards, and am certain that the new standards will improve efficiency and reduce the number of customizations and workarounds. We won't be able to say goodbye to those nasty Companion Guides, but at least they will be thinner. Besides reducing ambiguity in hundreds of passages -- saying when NOT to send data as well as when to send it, for example -- the updates incorporate a number of issues currently vexing implementers... 835 Remittance 837 Claims HIT Policy Standards Development Martin Jensen 2008-07-14T16:13:45-05:00 http://blog.hittransition.com/2008/07/new-hipaa-stand.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/323555014/npitaxonomy-cro.html Are you a provider having trouble meeting the Provider Taxonomy requirements of one -- or several -- of your payers? Are you a payer learning the hard way that the Taxonomies you ask for and the ones you actually get are many miles apart? If it's any consolation, you're not alone. But now, there's hope.... 837 Claims NPI - National Provider ID Provider Taxonomy Martin Jensen 2008-06-30T16:45:25-05:00 http://blog.hittransition.com/2008/06/npitaxonomy-cro.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/318497618/npi-irs-letters.html We were a bit surprised to hear so little about the impact of the new "NPPES must match IRS" policy we reported on two weeks ago and subsequently dug into in relation to the secret crosswalk logic the next day. Letters were supposed to go out right away. Providers should be getting them within a couple days, and then we would know the facts, which rarely get full exposition in formal CMS announcements. We saw the search stats go up as people Googled IRS+NPI, IRS+NPI+crosswalk, etc., so we figured word must be getting out. Wait For It... Then comes this note posted to a public listserv: "We have had a pharmacy report that they received one - they said it took 9 days to reach them and they were concerned that they only had one day to react before being cut off!" Totally Tubular, Dude! Hello? If that's true, we have a big wave about to break. A potential tsunami that could make May 23 look like a...well, a pretty good breaker, with a tube and a long reach, but still, just a regular wave..... Contingency Medicare NPI - National Provider ID Martin Jensen 2008-06-23T19:18:38-05:00 http://blog.hittransition.com/2008/06/npi-irs-letters.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/312547503/we-will-help-yo.html If you came here looking for free information about your NPI problems, you will find lots of it. Click here for more than 125 articles we've posted on the subject in the last three years. We'd like to help you more directly, if we can. For the past few weeks, we worked on a concept to develop a "Crosswalk Coach" service that we could streamline and offer at a bargain-basement price to help the small clinics and others who were looking at years and months of Medicare denials. We even drew up a clever superhero character to represent the guy who would get you safely across the street. No Cookie Cutter We had to abandon the concept. There are no cookie cutter approaches to this problem. We've learned that some providers are simply in a catch-22 situation, where solving one payer's problem only creates problems for others. We can help solve some of those problems, but not necessarily all of them. You may be experiencing an issue that can be fixed quickly, and we hope you do. But we simply can't guarantee anyone safe passage, as much as we'd like to. So, in our forthright sort of way, we will offer instead... 837 Claims Contingency It's All About Us Medicare NPI - National Provider ID Martin Jensen 2008-06-15T14:42:20-05:00 http://blog.hittransition.com/2008/06/we-will-help-yo.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/310553588/first-look-cms.html Yesterday we posted the first public glimpse of the logic that Medicare is using to map incoming claims against providers NPPES (NPI) records to find matching Medicare PECOS (enrollment) records. If you missed it, you can download the spreadsheet here: MatchingRecipesWithCounts05_27_08.xls We also published an analysis of what CMS's new warning about NPPES/IRS mismatches might mean to providers who thought they were safe (see CMS Adds IRS Domino to Tumbling NPI Data). If you get a letter from CMS, will the changes they force you to make create a problem that requires an 855 enrollment (PECOS) update? If so, it could result in months of suspended claims. The crosswalk file gives us a clue, especially since it gives daily counts of which rules are firing.... Contingency Medicare NPI - National Provider ID Martin Jensen 2008-06-12T12:30:44-05:00 http://blog.hittransition.com/2008/06/first-look-cms.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/309979589/grants-for-june.html Highlights of government and private grants for healthcare technologies for June, 2008 EHR - Electronic Health Records Grants and Funding Medicare Rural Healthcare Michael Christopher 2008-06-11T17:45:10-05:00 http://blog.hittransition.com/2008/06/grants-for-june.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/309934121/are-we-profitin.html This is the post where we publish the Medicare NPI Crosswalk. SHHH! Don't tell.... Contingency It's All About Us Medicare NPI - National Provider ID Martin Jensen 2008-06-11T16:09:39-05:00 http://blog.hittransition.com/2008/06/are-we-profitin.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/309610327/cms-adds-irs-do.html Back in the day, I used to believe that everyone in this industry was operating with the best of intentions. Increasingly, though, I am starting to side with the most cynical of my provider colleagues who think that Medicare just doesn't want to pay claims. Even as the Department's non-compliant, non-transparent NPI edits are quietly snarling claims all over the US, they have added a new flaming hoop to the race course: Your NPPES (NPI) data must not only match your OSCAR (Medicare enrollment) record, it must also match what the IRS has listed -- somewhere -- as your legal business name.(LBN) Here's what the notice says, and here are the staggering implications... Contingency Medicare NPI - National Provider ID Martin Jensen 2008-06-11T07:59:56-05:00 http://blog.hittransition.com/2008/06/cms-adds-irs-do.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/308337145/solutions-for-t.html Thanks to Jose Luis Gonzalez at ANCO for posting a link to this document by Medicare carrier NHIC, which lists their top 3 NPI errors and how to solve them. Interestingly, the solutions generally seem to indicate a "less is more" approach -- take stuff out to get the claim through. The one-pager is remarkalby succinct and actionable. A good example of the kind of transparency we've been advocating CMS adopt house-wide. Though NHIC's tidy little message falls far short of a full explanation of how Medicare is crosswalking claims data to PECOS data, it should provide a good guide for providers encountering the edits they list (M402, M417 and M419; M381 and M379, respectively) Contingency Medicare NPI - National Provider ID Martin Jensen 2008-06-09T16:47:10-05:00 http://blog.hittransition.com/2008/06/solutions-for-t.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/305432905/npi-rejection-r.html Medicare shoots out one carefully-worded story and it starts bouncing around the echosphere: Our Experts Agree, Everything Is Fine. This version comes from the HFMA website: "most of the Medicare contractors [are] reporting that over 90 percent of claims are NPI-compliant." We immediately posted our response, which said, basically, that "NPI-compliant" was a meaningless term, since it didn't address whether the claims would be properly crosswalked or paid, and that even 10% was an awful lot of rejections, when it comes to Medicare. But in absence of any real news (like real adjudication rates, real payment levels, etc.) from Medicare, the story keeps bouncing around the HIT world. Okay, here's some news, folks. Taken directly from CMS's own statistics, using a "per business day" calculation based on 250 working (and billing) days per year against unadjusted 2006 numbers. 10% of daily Medicare claims means that 386,853 claims are bouncing every day. 10% of daily Medicare payments means that providers are going unpaid to the tune of $149 million every day. Today is the 10th business day since May 23. Do the math: 4 million claims, $1.5 billion dollars. Here's the other news: Medicare's numbers are grossly underestimating the problem. Why?... Contingency Medicare NPI - National Provider ID Martin Jensen 2008-06-05T11:06:18-05:00 http://blog.hittransition.com/2008/06/npi-rejection-r.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/304879863/reader-mm5980-s.html Yesterday, an alert reader caught the notice that CMS had recinded MM5980, the Medlearn Matters article that told Medicare providers they need to violate HIPAA by plugging in their own NPI when a secondary provider (Referring, Ordering, Attending, etc.) did not have an NPI. (See Is Medicare Backing Off Noncompliant NPI Strategy?) Now, an even more alert (or perhaps well-connected) reader, let's give her the code name Mrs. Plame-Wilson, says somebody inside CMS told her it's just a content-related error that prompted the memo to be withdrawn. The rules haven't changed since Medicare changed them. Don't worry, you can still add the spaghetti code to do that noncompliant kluge that will get your claim past our edits. (I'm paraphrasing here, to protect my source's Covert Ops status.) In other words, "We're still going to violate HIPAA." Which Gorilla Do You Listen To? Behind this happy news come even more stories about small providers getting bad advice. One says that her Medicare contact told her to enumerate her small clinic, even though it is a sole proprietorship and the doctor/owner already had his own NPI. Another said that Medicare of Florida/First Coast is telling her that she needs to put their service facility information -- for 200 sites! -- into the Billing/Pay-To loop instead of where the 837 rules say to put it (clue: loop 2310D is referred to in the 837P as "SERVICE FACILITY LOCATION"). And they also say she needs to submit the claims in 200 different batches.... Contingency Medicare NPI - National Provider ID Martin Jensen 2008-06-04T18:00:06-05:00 http://blog.hittransition.com/2008/06/reader-mm5980-s.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/303815050/is-medicare-bac.html Alert Reader "ImNPIready" (I'm pretty sure that's a pseudonym) noticed that Medicare's instructions to falsify NPIs to get past their own edits seem to have been withdrawn. In a message distributed last night to Medicare Fee-For-Service lists comes the terse announcement: Article MM5890 has been rescinded. While we do not normally remove articles from publication, MM5890 was removed per CMS instructions. We've railed about this here -- like a lot of the issues we cover, it's got some technical nuance to it, but the basic instruction was "If you can't find an NPI for a secondary provider, put your own NPI in as the identifier for Referring, Ordering, Attending, etc." The problem with the instruction is that it overturns the fundamental principle of standards (that a data element refers to what it is supposed to refer to, not some other receiver-specific value) and the law itself (the Transactions and Code Sets Final Rule says no one can redefine or repurpose a data element).... Contingency Medicare NPI - National Provider ID Martin Jensen 2008-06-03T10:26:53-05:00 http://blog.hittransition.com/2008/06/is-medicare-bac.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/303284913/misys-aids-cust.html Medicare may love the numbers it is getting, but billing software vendor Misys wants to help their provider customers before they overwhelm their tech support department. So late last week, they sent out a fax broadcast. Download rejectionsfaxanon.jpg Due to the high number of rejections, Misys is receiving a record number of phone calls to assist you with intrepreting and resolving these rejections. Here are some suggestions for how to troubleshoot rejection problems before calling Misys. Given our own analysis, which suggests that, even after the Medicare SNAFU is largely behind us, providers will be confronted with a mounting series of unattainable, conflicting payer instructions, we particularly appreciated the validation in the vendor's first recommendation: Check out the new section link on our NPI website for Payer Specific NPI Issues. Wait, wasn't the purpose of NPI to let providers out of the Flaming Hoop Identity Relay? Contingency Medicare NPI - National Provider ID Martin Jensen 2008-06-02T17:36:46-05:00 http://blog.hittransition.com/2008/06/misys-aids-cust.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/303121299/medicare-admits.html Despite widespread reports of significant claim disruptions, Medicare issued a note that says that "the favorable trend in NPI compliance is better than we expected with most of the Medicare contractors reporting that over 90 percent of claims are NPI-compliant, with some reporting 100 percent compliance." I never trust it when anyone uses that c-word. CMS has assiduously avoided defining "HIPAA-compliant" in the long history of Transactions and Code Sets implementation, so "NPI-compliant" should not be taken to mean what this soft-pedaling would lead one to believe. (It's also worth noting that 10% of Medicare claims is an awful lot of unpaid bills.) The real question is, "How many claims are getting through adjudication?" Even gettting Medicare to "accept" the claims is, as so many have learned, no guarantee, as notice of crosswalk failures sometimes appear in the form of ADR letters received weeks after the claim was "accepted." And yes, those claims could easily have been "NPI-compliant" -- in fact, lack of a legacy ID is one of the things that leaves Medicare's crosswalking process clueless as to how to pay. If All Else Fails, Contact Someone Who Cares In a pale acknowledgment of the problems that have already vexed some providers for months, the letter offers a glimmer of hope... Contingency Medicare NPI - National Provider ID Martin Jensen 2008-06-02T12:31:06-05:00 http://blog.hittransition.com/2008/06/medicare-admits.html http://feeds.feedburner.com/~r/hittransition/NIxI/~3/301574481/emdeon-medicare.html Breaking news from Joe Conn at Modern Healthcare: Medicare and Medicaid rejections are still huge after a week of effort, according to Miriam Paramore at Emdeon. I have to tell you how brave it is of them to state this publicly, since their customers are likely blaming them for the problem. Isn't it the clearinghouses's job to fix stuff like this? Regular readers will know that the smoking gun lies elsewhere. Just click on the NPI category on the right side of the page for about three years of clues. I would also like to point out that the 25% rejection rate is not an indication that every provider will see their Medicare check drop to 75 cents on the dollar. Instead, many will see no impact at all, why a few (that's a word I borrowed from CMS to describe NPI crosswalking problems) will get a big fat goose egg. It's almost seven and it's Friday night. Busy week. Gotta go, folks. Keep posting your own NPI stories on our Open Thread. Contingency Medicare NPI - National Provider ID Martin Jensen 2008-05-30T18:56:26-05:00 http://blog.hittransition.com/2008/05/emdeon-medicare.html