Statement To

DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

SUBCOMMITTEE ON STANDARDS, AND SECURITY

May 1, 2007

Presented By: Michael Ubl

Director eHealth & IT Strategy – Blue Cross Blue Shield of Minnesota

WEDI Board Chair-elect

Chairpersons and members of the subcommittee, I am Mike Ubl, Director of eHealth and IT Strategy with Blue Cross Blue Shield of Minnesota (the largest health plan in Minnesota), and serve on the WEDI Board of Directors. One of my responsibilities for Blue Cross Blue Shield is to implement HIPAA regulations and other process improvements for our Plan and its affiliate organizations.

At the request of NCVHS, WEDI recently conducted its fourth National Provider Identifier (NPI) Readiness Assessment survey so that we can report on industry readiness. The survey was conducted between April 2^nd and April 13^th , 2007. I would like to thank you for the opportunity to present testimony on behalf of WEDI concerning findings from this survey. As a point of reference, WEDI’s four NPI Readiness Assessment surveys were conducted during the following periods:

• Survey #1 --- May 2006
• Survey #2 --- October 2006
• Survey #3 --- January 2007
• Survey #4 --- April 2007

WEDI provided testimony to NCVHS on this topic back on January 24, 2007. At that time, WEDI provided its assessment of NPI readiness across the industry based upon results from its second survey, which was conducted in October 2006. The information I will share today will focus on the progress made by the industry in the past three months, leveraging the data available from the third survey conducted in January and the more recent information from the April survey results.

Summary of Survey Findings

I am pleased to say that we have seen some progress in a variety of areas, while at the same time the data continues to confirm that many within the industry will not be ready to fully implement the use of NPIs on May 23, 2007. From a demographic perspective there were fewer returned surveys in April (841) than January (1100+). Most of the decrease centered on healthcare providers as there was actually an increase in the number of responses from health plans and clearinghouses. There were 866 provider survey respondents in January 2007 as opposed to 560 provider participants in April. The number of health plan respondents increased from 156 to 181. The drop in responses from healthcare providers could be attributed to a shorter timeframe for the survey and the fact that it overlapped with Easter and spring breaks. The mix of participants was similar in each survey. Due to limitations in the survey tool used by WEDI, any given survey responder has the option of skipping individual questions. Hence, the information provided is presented in terms of percentages, reflecting the results of those who responded to an individual survey topic.

The table on the following page provides some perspective on industry progress over the past three months. I want to emphasize that WEDI believes survey participants represent the more diligent part of the industry in terms of NPI planning and execution. The information should be viewed as the ‘best case’ scenario.

Some of the important findings from this survey:

• The number of providers in the survey that obtained their NPI improved from 95% to 97% of respondents. One can expect the last couple of steps in reaching 100% to be the most arduous.
• The number of providers that have shared their NPIs with health plans showed a significant increase from 25% to 49%. Great progress, but still far short of the goal for May 23, 2007.
• Provider capability to support NPI transaction processing has jumped considerably. For example:
  1. Providers able to submit claims with dual-identifiers improved from 25% to 52%
  2. Providers able to submit claims with NPI only improved from 4% to 19%
  3. Providers able to accept a remittance with NPI only jumped from 7% to 26%
• Health plan capability to support NPI transaction processing has also shown improvement. For example:
  1. Health plans able to accept claims with dual-identifiers improved from 66% to 75%
  2. Health plans able to accept claims with NPI only improved from 13% to 34%
  3. Health Plans able to send a remittance with NPI only improved from 4% to 21%
• In terms of an individual organization ‘capability’, the industry has demonstrated real progress. However, the current transaction volume with NPI data would indicate that the migration process is still lagging. Seventy-eight percent (78%) of health plans reported that 25 % or less of their incoming electronic claims contain an NPI. This decrease is an improvement of only 7% (85% in January). WEDI concludes that the actual testing / migration process between business partners to the NPI world is complex with a variety of testing and validation challenges.

Table #1

Key Outstanding Issues

The past twelve months have been a difficult time for the industry with regard to NPI implementation. WEDI commends NCVHS for its leadership role in bringing together a wide variety of industry groups and listening to the challenges faced by healthcare organizations across the country. For your efforts, I want to express my appreciation on behalf of WEDI and the organizations that it represents. The Contingency Guidance announced by CMS on April 2, 2007 was certainly welcome news. I want to assure you that WEDI and its members do not take the NPI situation lightly. Recent discussions with my colleagues in the industry indicate that there is no ‘let up’ on the work efforts. The information provided today confirms we have a long uphill battle still ahead, and we will continue with our education and outreach efforts. There are several issues that I would like to bring to your attention as we prepare for the contingency period after May 23, 2007. They include the following:

• NPPES Dissemination – This is an ongoing problem. I understand that the final regulatory language is currently under review by the Office of Management and Budget (OMB). However, lack of access to a central source for NPI information is a significant problem. Providers do not always have a clear understanding about, how, and to whom, they should share an NPI. Labs and pharmacies face a similar problem, without access to NPPES, there is not a way for many labs and pharmacies to generate a payable claim because referring, ordering, and prescribing providers are required on their claims.

  Recommendation: CMS must provide an operational system that supports timely access to NPPES data for industry constituents. WEDI recommends the following:

  1. CMS publish the NPPES Dissemination notice as quickly as possible.
  2. CMS establish a thirty (30) day time period for public comment. WEDI is positioned and ready to partner with CMS on this item. With our industry presence, WEDI can quickly convene representatives from across the healthcare industry to review and provide feedback on the proposed process.
  3. NPPES provide a system solution with electronic access to NPI data no later than 120 days after publication of the NPI Dissemination notice.

• Assignment of UPIN numbers – CMS has announced that UPIN numbers will no longer be issued after May 23, 2007. In addition, access to the UPIN file will be discontinued by June 30, 2007. This creates a serious problem for providers / health plans that currently use the UPIN as a legacy number for claim adjudication and payment. In Minnesota, there are large healthcare providers who use UPIN for this purpose. Based on recent listserv activity, I can safely conclude that Minnesota is not the only state facing this particular problem.

  Recommendation: WEDI recommends that CMS implement the following:

  1. Continue issuing UPIN numbers beyond May 23, 2007, consistent with the NPI Contingency Guidance announced in April 2, 2007. Given that this is a number widely utilized by the industry (beyond Medicare), issuance should continue until May 23, 2008. Providers that use UPIN as their legacy number, but will not migrate to business operational use of NPIs until sometime after May 23, 2007, will need an ability to acquire UPIN numbers for new service providers.
  2. Continue to maintain and make available the subscription UPIN database through the full contingency period; and
  3. Ensure that the UPIN online registry capability continues through the full contingency period.

  Implementation of these steps will prevent the potential for business interruptions during the contingency period, and allow healthcare organizations to focus their resources on the primary goal of NPI compliance by May 23, 2008.

• Variations in the duration of individual Contingency Plans – The CMS contingency guidance states that entities may elect to end their contingency plan prior to May 23, 2008. In principle, this is sound rational thinking. However, entities should exercise discretion in discontinuing their contingency plan unilaterally if it poses significant risk to business operations with some of its business partners during the contingency period. As an industry, we need to adopt a goal of getting through the NPI contingency period with all entities compliant, while not disrupting business operations. Business continuity must be viewed as a higher priority than simple NPI compliance during the contingency period.

  Recommendation: WEDI recommends the following:

  1. CMS issue an FAQ or additional guidance that advises caution on the unilateral ending of contingency periods. Unilateral ending places undue business discontinuity burdens on those trading partners who are still dealing with third parties who are not ending contingency periods. So whether from the perspective of accepting 837s or accepting 835s or both, it is advisable that key trading partners collaborate around the timing for discontinuation.
  2. Health plans communicate their contingency plans to their trading partners as quickly as possible. WEDI wants to recognize the action taken by CMS Medicare on this subject. On April 20, 2007, CMS published its NPI Contingency Plan for Medicare Fee For Service (FFS). WEDI applauds CMS for its leadership role in communicating its own contingency plan, and encourages health plans to follow the example of CMS. Early communication of contingency plans in a clear and concise manner will insure a smooth transition to NPI compliance.
  3. CMS collaborate with the National Provider Identifier Outreach Initiative (NPIOI) on creating an NPI Transition Plan that provides guidance to the industry on achieving NPI compliance.

In conclusion, I want to assure NCVHS that the industry is making progress. WEDI intends to continue with its NPI Readiness Assessment surveys every quarter through May 2008. We will monitor and update both CMS and NCVHS on our survey findings as well as escalate important issues as they arise. Thank you for your time today. WEDI looks forward to working closely with CMS and completing the long journey to NPI industry compliance during the contingency period between May 23, 2007 and May 23, 2008.

Sincerely,

Michael Ubl

WEDI Board Chair-elect