NPI: Challenges Remain

In a May 29 Modern Healthcare Posting entitled "Claims processors see
rejections spike with NPI," Joseph Conn mentions the impact of NPI on claim rejection rates. Implemented around a holiday weekend, early "grim reports" suggest a massive increase in claims rejection rates. The lead paragraphs summarizes the posting:

"Healthcare industry claims processors and claims-flow watchers report at least fourfold increases in rejected Medicare claims, similar or even higher rejection rate spikes for Medicaid claims, and a doubling of rejection rates for claims processed by Blues plans on May 23, the first day a federally mandated National Provider Identifier was required."

A senior VP at Emdeon states “We’re seeing a rejection rate of 24%,” ......By Emdeon’s analysis, this individual reports, this represents "$25.8 million in claims that were turned down, which compares with an average rejection rate of 6% or $10.6 million before May 23." Medicaid rates published by Emdeon are similarly high. The rejection rate is 26% compared to a normal rate of 4%. Blue Cross claims however, saw less of a spike according to this authority, jumping from 3% to 6%.

For Medicaid claims processed by Emdeon, the rejection rate on May 23 was 26% compared with a normal rate of 4%; and for Blues claims, 6% were rejected that day compared with a norm of 3%. An industry trade group spokesperson mentioned a 42- physician practice group in which only 12 of the 42 physicians could submit claims without them being rejected. Another spokesperson mentioned a "state Medicaid official who said claims flow had fallen from a normal 100,000 a day to less than 20,000."

What does this mean for our preparedness for health IT? Time and again, there seems to be a disconnect between federal thinking and results on the ground. This disconnect seems to happen even even when the thinking is very sound and accepted by the majority of stakeholders.

What does this mean for e-prescribing? Presumably, problems with a mandate - even with plenty of lead time - might be of a similar magnitude. These possible problems should not deter our industry from pursuing these goals, but it should reinforce our commitment to ensure that transitions are effective. Rejected claims mean money and when money is to be had, people find solutions. Problems with e-prescribing may mean at least a temporary access to medications for those who take these medications to prevent far more serious illness.

These "frightening" reports on NPI should stimulate the medication management industry to ensure that authentication is reliable, authorization is valid, and that the entire process among prescriber/refiller, dispenser, and consumer runs smoothly. We can ill afford stories on e-prescribing similar to the NPI anecdotes provided by Modern Healthcare