MGMA suggests provider ID refinements
MGMA suggests provider ID refinements
Group suggests phase-in to ease practice burden
The Englewood, CO-based Medical Group Management Association (MGMA) has submitted suggestions for refining HCFA's proposal for creating a standard format for submitting claims electronically, saying it favors a more streamlined administrative system when it comes to electronic claims submission but is "leery" of the regulatory rule-making process.
Under the HCFA standard proposed on May 7, health care providers would apply for an eight-digit identifier to use whenever processing claims electronically. They would apply for that identifier only once and keep it when they move from one state to another, or if they change specialties.
Also, every provider would have the option of using a single standard electronic format to bill for services rendered. All health plans would be required to accept these standard electronic claims. Currently, different insurers use different electronic and paper claims forms, creating a confusing and cumbersome system for health care providers and taking providers' time away from their patients.
The electronic claim proposal also includes new standards for other common transactions and for reporting diagnoses and procedures in the transactions. Health plans will be able to pay providers, authorize services, certify referrals, and coordinate benefits using one standard electronic format for each transaction. Providers will be able to inquire about the status of a claim or whether a patient has insurance coverage, or request authorizations for services or specialist referrals.
Employers who provide health insurance to their workers and their dependents also will be able to use a standard electronic format to enroll or disenroll employees and to make premium payments to any health plan with which they contract to do business.
MGMA is concerned that the way the adjustment phase-in segment of the provider ID change over is structured would place too great a drain on the time and resources of most group practices. The phase-in is scheduled to take effect in two years.
As part of its comments filed with HCFA last July, MGMA is instead lobbying for an alternative three-stage implementation process structured along the following schedule:
Stage One - National standards for health care identifiers for providers, payers, and plans should be fully implemented two years following their respective final publication dates.
Stage Two - All transactions, including national standards for claims attachments and national standards for health data security, should be fully implemented two years after the publication of these respective final rules.
Stage Three - The individual identifier should be fully implemented two years after publication of its final rule.
However, in its comments filed with HCFA, MGMA also argues no changes should be implemented before passage and institution of comprehensive standards guaranteeing the privacy and security of electronically transmitted health-related data.
Concerned that HCFA's proposed definition of a "health care provider" is too broad, MGMA also wants to limit any national provider identification numbers to physicians. "From the proposed definition, it appears as though [groups like] billing entities could also receive NPIs," the association told HCFA in its written comments.
The proposed rule has two levels of electronic access. The first level would be for enumerators only and would include all the data elements in the system. The second level includes the following data elements: provider name, address, NPI, resident/intern code, enumeration date, group member name, other provider type and number, and provider classification.
According to the proposed rule, the term "public" refers to individuals, providers, health plans, clearinghouses, and vendors. MGMA says access to the National Provider System (NPS) - the provider data bank - should be restricted solely to enumerators, with no public access without prior provider approval. MGMA contends that the NPS should not release more information than the Unique Physician Identification Number registry currently disseminates.
The cost for providers to implement the NPI would be two hours and $60 per entity, according to the proposed rule.
MGMA, in its comments to HCFA, argues that these hours/expense estimates are too low because it is estimated that it will cost a group practice at least $2,000 to upgrade its software. "This figure could rise substantially if the administrative simplification provisions were implemented non-harmoniously. Costs would increase dramatically if software had to be revised several times in a short time to accommodate the new regulations," MGMA's comments say.
HCFA's proposed rule also would replace the "J" code for the National Drug Code electronic claim form. As the current HCFA 1500 paper claim form does not accommodate the 11-digit NDC codes, MGMA maintains that "J" codes should not be eliminated until both the electronic and paper HCFA 1500 claim forms are redesigned to fit the NDC code.
MGMA supported adoption of the Physician's Current Procedure Terminology (CPT) code set and CPT standard modifiers for procedure reporting. MGMA also stated that no electronic standard should be implemented prior to the modification of appropriate paper and electronic forms to accept all the new standard codes.
The proposed rule states that beginning in 2000, local codes are to be eliminated and a national process is to be established for reviewing and approving codes that are needed by any public or private health insurer. MGMA's position is that any incorporation of a national system of local codes should include the applicable modifiers, and if certain temporary codes are created, a mechanism must be developed to sunset these temporary codes.
MGMA opposes the institution of any user fees for NPI enumeration or NPS information updates on providers due to a concern that health care providers will end up paying for HIPAA implementation through user fees and financial penalties.n
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.