News Briefs

Providers reminded NPI required beginning Jan. 1

Claims without it 'unprocessable'

Beginning Jan. 1, 2008, the Centers for Medicare & Medicaid Services (CMS) will require hospitals and other health care providers to use a National Provider Identifier when they bill Medicare fiscal intermediaries and Medicare administrative contractors, the agency said in a recent notice.

Claims that contain only a legacy provider identifier in the primary fields will be returned as "unprocessable," CMS said. The agency said it was taking "the next step toward full implementation of the NPI" because the "vast majority" of institutional providers already include the NPI on their Medicare claims.

Providers may include both an NPI and legacy identifier in the primary fields through April 2008. CMS recommends, however, that they submit at least some claims with only an NPI to ensure their claims will be processed successfully when an NPI alone is required beginning May 1, 2008.

Rejected claims, delayed reimbursement, and potentially lost reimbursement will result if hospitals don't have the proper processes in place, cautions Beth Keith, CHAM, senior management consultant for ACS Healthcare Solutions.

Providers should have taken the following steps, Keith says:

  • Obtained NPI numbers for all required providers;
  • Cleaned and corrected existing provider master files;
  • Mapped a crosswalk with NPI numbers and UPIN, payer identifiers, etc., for all providers

The change affects providers' information technology systems as well as their reimbursement, Keith notes, in that current claims processing systems must accommodate the NPI identifier. t

ED visits up by 5.1 million according to CDC report

Visits to hospital emergency departments increased by 5.1 million in 2005 to 115.3 million, according to a recent report by the Centers for Disease Control and Prevention.

That is an average of about 30,000 visits per ED, nearly one-third more than in 1995. The ED visit rate for patients without health insurance was about twice that of those with private insurance, according to the report. Infants under age 1 had the highest visit rate by age. The leading diagnosis for children under 13 was acute upper respiratory infection.

Other top diagnoses by age were bruises, adolescents; abdominal pain, adults under 50; chest pain, adults 50-64; and heart disease, seniors. About 12% of ED visits resulted in hospital admission. The leading diagnosis at discharge was heart disease.

The 2008 edition of AHA Hospital Statistics, which came out in late October , includes figures regarding ED usage in 2006. It reports that hospital EDs served 3.6 million more people that year than in 2005, while the number of inpatient admissions held steady.

ED visits totaled 118.4 million, up from 88.5 million in 1991, according to the AHA survey. Contributing to the rise in visits, it reported, is the increased use of hospital services from baby boomers who recently turned 60, an age when use of health care services begins to go up dramatically.

AHA survey report outlines uncompensated care costs

The cost of uncompensated hospital care in the United States was $31.2 billion in 2006, up from $28.8 billion in 2005 and $21.6 billion in 2000, according to the latest figures from the American Hospital Association's Annual Survey of Hospitals.

Underpayment by Medicare and Medicaid reached nearly $30 billion in 2006, up from 25.3 billion in 2005 and $4 billion in 2000. Medicare reimbursed 91 cents and Medicaid reimbursed 86 cents for every dollar hospitals spent caring for these patients.

In 2005, 65% of hospitals received Medicare payments less than cost and 77% of hospitals received Medicaid payments less than cost.

AHA President and CEO Rich Umbdenstock says survey data show that "hospitals are seeing more and more patients while future financing is uncertain, emergency departments continue to be overcrowded, and fewer workers are available to provide care."

The information is summarized in two AHA fact sheets, available on-line at