CMS Announces Contingency Plan for NPI Compliance

BALTIMORE–On Monday, CMS announced that health care providers
that can’t meet the pending May 23 deadline to become compliant
with National Provider Identifier provisions will have another year
to do so.

For up to 12 months after the deadline, suppliers covered under
the Health Insurance Portability and Accountability Act will now be
able to implement contingency plans if they have tried in “good
faith” to comply, CMS said. Such contingency plans could include
accepting legacy provider numbers (those currently in use) on HIPPA
transactions in order to maintain operations and cash flow,
according to an agency press release.

HIPPA-covered entities had until May 23 to be compliant with the
NPI provisions, except for small plans, which had until May 23,
2008.

However, CMS said, “it became apparent that many covered
entities would not be able to fully comply” by the deadline.
Therefore, the agency said that up until May 23, 2008, it will not
impose penalties on suppliers or other covered entities “if they
continue to act in good faith to come into compliance, and they
develop and implement contingency plans to enable them and their
trading partners to continue to move toward compliance.”

Medicare will announce its own contingency plan shortly, CMS
said.

The NPI is an identifier that will be used to identify health
care providers on all HIPAA-covered transactions, replacing all
legacy identifiers that are currently being used such as Medicaid
provider IDs, individual plan provider IDs and UPINs, etc.

While the Medical Group Management Association called the move a
“critically important decision,” the group practice organization
said the necessity for the extension “was due in part to CMS’
failure to publish their data-dissemination policy in a timely
manner and facilitate the communication of NPIs.”

To download a CMS document explaining the contingency guidance,
click here.

For more information on applying for an NPI, visit the National
Plan/Provider Enumeration System Web site at https://nppes.cms.hhs.gov/.