Home Forums Discussions General Discussion National NPI, Read 'em & Weep

Folks,
The local Onondaga County Medical Society just sent our a letter that the AMA, MGMA just signed off on and sent to our "Lovely" Sect. Levitt. Here is a link for the research that is the basis for their letter. There is a good chance that approx. 69% of all claims submitted would get rejected if they move forward with the May 23rd deadline for this stupid thing. But I'm sure that his friends in the Insurance industry are hoping that such is the case, seeing that much of the compliance issues has little to do with doctor PM software anymore, and much more to do with the connection and the software involved between the carriers and the clearing houses.

How's that for a nice windfall profit for them??? Tons of rejected claims, many that will eventually be paid, but I'm sure significant number of them will simply get lost... Gee I wonder who that would benefit most??? The Gov't and CMS? Their friends at the big carriers perhaps??? Naaaaa, they wouldn't do that to us now would they..... Watch out because here it comes.....

http://www.emdeon.com/newsroom/npi_guidelines_industry_version.pdf

Good Night and Good Luck,
Paul

Paul:

CMS is flirting with disaster and one day they will "cross the line" leaving most physicians with no choice but to disenroll. Here's another article on this that I ran into last night that discussed this issue:

Health Care Providers Unprepared for NPI Deadline, Reports Find
http://www.ihealthbeat.org/articles...PI-Deadline-Reports-Find.aspx?topicID=56

What I don't get is that on the HICF form we have to provide the NPI, the UPIN number, the old BS Medicare number, and in some cases even the CLIA and tax ID numbers. The NPI is a good thing, but why not simply have ONE number, preferably the tax ID number?

Cheers,
Al

Al,
That is the purpose of the NPI, that will be you, Al, Bert, Nancy whomever forever and forever. I think it will stick with you where ever you go too. So you move, you switch from a large group into your private practice or visa versa, that one number will always be Al's number. So in a real sense that is what we are getting, kind of good and easy, but it kind of follows you with all your bumps and bruises too. Now most of you high quality folks have nothing to worry about here, but in a real sense it's another big brother kind of thing too. "It's on your permanent record young man!"

And tax ID's don't serve the same purpose because folks in groups all share a tax ID number. Come on a really business savvy guy like you doesn't know the drill??? This is why so many docs are joining these every increasingly large, factory style practices, not because they like one another or even have a single pinky finger's worth of professional respect for each other either, it's to get around the anti-trust and Stark laws. Docs who share a tax ID number can negotiate as a group against these anti-trust waived Cartel insurance carriers! Get it? So like here in the Binghamton area, almost all of the greater three cities area is most covered by one big ugly group, UMA, United Medical Associates, and somewhere back there, there are like half a dozen, a dozen Associates. And the real aweful thing about it is, they still don't have nearly enough leverage to fight back against the state, the fed's or the major carriers to get any really worthwhile concessions in the terms of the contracts or increases in fees. But now they have to have useless meetings with lots of supposed associates whho can not influence policy worth a damn.

No one at this place feels like it is their practice and they all have retarded restrictive contracts, with aweful performance based contracts that like with P4P at some point you become a donkey chasing your own tail. The only way to make it work is to at some point let your performance slip just so you can start bumping it up again. It just insane. And then someone like Nancy who became the "female dumping ground" for all the pain in the neck, needy tissue box visits, with lots of low paying products (which kind of patients are the neediest??) can't even get started. Meanwhile a lot of the guys, can get 4 or more quicky strep throats in and out in about an hour, while Nancy had one or two an hour that took four times as much charting (paper) to complete. Oh yeah, don't even think about picking your own EMR in a factory like this... It'll just get forced upon you by the "managing Associates".

Anyway, every time you switch groups or start a new practice it is a new business entity and therefore it is a new tax ID number with the state and the feds. So that is why none of you here in small and solo practice are allowed to act collectively, it is a violation of all these laws. You are all separate and distinct tax ID numbers. But if you guys wanted to totally throw away any control over your own destiny and practices, you could all merge, probabably even across state lines (UMA has offices in NY and PA) and try to form some form of a Mega group and some out there are trying to form these mega groups in the hope of regaining some amount of leverage, but the real reason must docs join such a place it to let someone else and lots of staff take care of and worry about most of the things we all worry about and deal with every day... Not to fight back but instead to let go.

And now you know why I am correct in framing these SOB carriers as Cartels. They have their anti-trust waiver and collude among themselves (and they do) all while using your gov't against you as both a provider as well as a comsumer of healthcare yourself, to tie you up in knots with ever increasingly tightening anti-trust legislation and "enforcement" from your own gov't. They really are an "f'ing" Cartel. Al post a few more oil cartel pics here for me, will ya???? Thanks.

What I don't understand is how since most of the screw up with this rollout is the carriers not getting their act and their software and systems together while most of us have as most billing packages that care to keep their customers have gotten on board with this already; This is very much rewarding the SOB's with windfalls in buckets for messing up. Instead the penalty for not being ready should be having to process and pay all these claims not that they are not in compliance waiving their right to hold back or argue any of them. Shut and pay, unitl you are in compliance. But instead they get to actually screw us it seems for doing a poor job.

So tell me if you were the VP in charge of tech services and IT at a carrier's place, why would you move ahead on time to roll out this NPI stuff??? The longer you screw up and drag your feet the better your company will do. Heck they are probably all getting paid bonuses for doing just that. I have not heard of any penalties at all for the carriers not being in compliance and ready for "D" day, have any of you??? So drag their feet they go, while lobbying behind the scences to not delay this rollout.... What a racket. Time for me to switch sides, what ya think??? I'll be one of those well paid, well dressed provider reps who come into your office, let you vent at them, nod their head, and then walk out the door to let things continue as always. Weekends and holidays off, off by 4-5 o'clock, full bennies with great health insurance coverage. Ya know, just were do these folks and their families get their healthcare. We have probably seem less than half a dozen such people in the four years we have been open. They must go to the factory down the road who always seems to have a better deal then we do... Oh right that whole tax ID thing....

Paul

Man Paul, you must have fast typing fingers, or else you are at work all day typing.

But I agree w/ you. The intent of NPI is to have ONE number. In the meantime, however they are doing a stupid thing. They are allowing for crossover time AFTER the deadline. They've been telling us for over a year "Sign up for your NPI." I've had mine over 1-1/2 years. But we've had to report all these other stupid numbers.

A deadline is a deadline. Start using NPI, drop the other numbers entirely. Why doesn't the CMMS listen to this messaage boards? I know, it's because they don't give a cr*p about us.

But the real killer is that most offices have done what ever they can to be ready for this because they know their bacon depends on this. Meanwhile it's everyone else, those wonderful software vendors and certainly the carriers who get to hold on to our money who don't give a rats behind about us that pretty much want this to screw up as long as possible and I'm sure are even doing anything and everything they can to drag this out as long as possible....

In my sport these guys would get a Gross Misconduct. Simply Amazing...

5 minutes in the penalty box!

No way. That's just a regular old Major. These guys get the full top penalty ever, the Match. Suspended for up to 30 days or until a hearing is held at which point the governing board can hand down further actions and suspensions...

We used to have the option of a Gross Misconduct, doesn't that sound worse, but actual it was between a game misconduct and a Match, so recently the rules committees of almost all sactioning bodies just cut it down to the two, a game or a match.

I'm in favor of suspending them from the League. Pull your punches, Hockeyref! Toss 'em out!