If you are one of those people who believe that giving our masters in Washington full control over our health care delivery system will make things more efficient, I recommend GruntDoc’s latest post on the National Provider Identifier (NPI).

For anyone lucky enough to be unaware of the NPI, it is the latest number that CMS has ordered providers (doctors, hospitals, pharmacists, etc.) to acquire or be banished to outer darkness. As is always the case with CMS brainstorms, the implementation of the NPI system has been a pig’s breakfast:

According to a June 11 CMS announcement, doctors will have to reconcile their NPI data with their IRS legal name data in order to get paid … Every aspect of the data must match, including the exact spelling of names, the use of initials and even blank spaces in the data. The slightest discrepancy could send Medicare claims back to the drawing board.

Obviously, the number of minor descrepancies between the CMS and IRS data will be very large and this will prevent lots of providers from being paid for legitimate services. GruntDoc points out that this another example of CMS moving the goal post:

So, Medicare issues a NPI, which isn’t checked against the IRS name, then retroactively and apparently without notice announces they’re not going to pay for work already done in good faith, over yet another clerical gotcha, in which they were complicit.  Breathtaking, the hubris.

This is what health care bureaucrats do. They capriciously impose rules and regulations that add no value and with which providers cannot comply (or even understand in many cases). Then, they penalize doctors, hospitals and other providers for not complying.

Is this inside baseball that patients can safely ignore? Nope. Medicare and Medicaid pay so poorly that doctors and other providers are already refusing to accept patients covered by these programs. The NPI boondoggle will make it even harder for Medicaid and Medicare patients to find PCPs.

And yet there are politicians who wish to give government apparatchiks more power over the health care system than they already wield.

Comments 1

  1. SmartDoc wrote:

    Most doctors have long since given up on Medicaid. The type of massive abuse in the NPI debacle, plus the coming 10.4% reduction in fees, should similarly bring about the end of Medicare widespread acceptance.

    Which is precisely what I suspect is the point of this outrageous misbehavior by the CMS.

    Posted 21 Jun 2008 at 9:59 pm

Post a Comment

Your email is never published nor shared. Required fields are marked *