Upload
jubal
View
30
Download
0
Tags:
Embed Size (px)
DESCRIPTION
National HIPAA Audioconference: Analysis of the National Provider Identifier. Preparing for the NPI Transition January 11, 2006. Preparing for the NPI Transition. Individual Providers If employed by an Organizational Provider Ask how/if employer plans to enumerate employed providers - PowerPoint PPT Presentation
Citation preview
National HIPAA Audioconference: Analysis of the National Provider Identifier
Preparing for the NPI Transition
January 11, 2006
Preparing for the NPI Transition
Individual Providers If employed by an Organizational Provider
Ask how/if employer plans to enumerate employed providers
What education will be made available? What is required of employed providers? Do I need an NPI?
Preparing for the NPI TransitionProviders
Individual Providers Private or Group Practice
Do I need an NPI? (Most providers will) How will I apply for an NPI? Gather data requirements
https://nppes.cms.hhs.gov/NPPES/Welcome.do Follow instructions carefully Use legal name Use standardized address (NPPES assisted)
Educate yourself on short and long term uses of the NPI
Own the process
Preparing for the NPI TransitionProviders
Organizational Providers Organize Implementation Team
Implementation Team – Core Members Business Office (PFS) Manager(s) Revenue Cycle Director / Executive Medical Staff / Credentialing Corporate Compliance Officer Information Technology (Clinical and Financial) Managed Care
Preparing for the NPI TransitionProviders
Implementation Team – Ad Hoc Members Chief Medical Officer Ancillary Department Managers Clinic Managers Health Information Management Human Resources Legal Training and Staff Development / Education
Preparing for the NPI TransitionProviders
Immediate education Core implementation team
Develop project plan with milestones Identified affected departments/ business units Identify affected Trading Partners and Business
Associates Identify affected processes, policies, and
procedures (Don’t forget Medical Staff By-Laws)
Preparing for the NPI TransitionProviders
Develop transitional strategies Application Enumeration (Subpart delineation)
Contract Review Regulatory Requirements
Education Employed Providers Medical and Allied Staff Referring Providers
Preparing for the NPI TransitionProviders
Transitional Strategies (continued) Taxonomy? Disclosure NPI Collection (Dissemination) Validation Testing
The Application Gap Referrals Pharmacy
Preparing for the NPI TransitionProviders
Information Systems Gap Analyses
NPI Taxonomy Legacy Identifiers Interfaces Reports - Internal and External Document Imaging / Archiving Technologies
Clinical E-Prescribing EHR / EMR
Software updates
Preparing for the NPI TransitionProviders
Communicate, Ask, Educate Health Plans Software vendors State / Federal Agencies (data submission) Third-party vendors (data submission) Other Business Associates
Preparing for the NPI TransitionPayers
Payers Assemble implementation team
Credentialing Authorizations / Medical Management Claim Processing (Electronic/DDE/Paper) Finance
Remittance Advice Premiums
Beneficiary Enrollment Information Technology
Preparing for the NPI TransitionPayers
Determine affected processes / departments Plan / product line specific Coordination of Benefits Subparts and the lack of subparts (The Granularity
Issue) Provider Services Legal Provider Contracts Workflow
System Mail Room
Preparing for the NPI TransitionPayers
Determine affected processes / departments (continued) Web Services Clearinghouses Settlements Reporting Fraud and Abuse
Ten digits of gloriously meaningless pixels / ink
Preparing for the NPI TransitionPayers
Develop Strategies Conversion / Crosswalk / Other Adjudication Methodologies and related processes
The Application Gap Post-implementation legacy/NPI support
NPI data collection NPI data validation Sequencing of software updates and transactions Testing Implementation schedule
Preparing for the NPI TransitionPayers
Develop Strategies (continued) Inbound validation
Pharmacy Transactions (PBMs) When is legacy compliant?
The Application Gap Communicate, Ask, Educate
Providers Clearinghouses Software vendors State / Federal Agencies (data submission) Other Business Associates
Preparing for the NPI TransitionVendors
Vendors Claim Clearinghouses Software Vendors Data Clearinghouses Data Warehouses
Develop Implementation Strategies Education Must be ready before customers Software updates Testing
Preparing for the NPI TransitionVendors
Develop Implementation Strategies (continued) Conversion / Crosswalk / Other NPI validation (Luhn only?) Sequencing of software updates and transactions Testing Implementation schedule
EVERYONE will be ready at different times Support of Dual Identifier Testing Strategy
Preparing for the NPI TransitionVendors
Ask, Ask, Communicate, Educate Payers Providers Other Trading Partners Other Business Associates
Preparing for the NPI TransitionVendors
The Application Gap Post-implementation legacy/NPI identifier support
issues
Preparing for the NPI Transition
Common Threads Communication Asking Education The Granularity Issue The Application Gap Our patients, beneficiaries, and their families
Preparing for the NPI Transition
Michael ApfelChief Privacy Officer
Truman Medical Centers WEDI National Provider Identifier Outreach Initiative
Steering Committee Co-chair, Education and Content Work Group WEDI
National Provider Identifier Outreach Initiative