HIPAA Collaborative of Wisconsin Fall 2007 Conference

HIPAA Collaborative of Wisconsin

Fall 2007 ConferenceNPI: Contingency Plans and Data Dissemination

Suzanne Stewart, EDI CoordinatorAurora Health Care

Milwaukee, WI

Agenda: NPI The Road That Lies Ahead

• General Information about Aurora

• The Contingency Road Map Smooth Roads – Positives

Pot Holes – Negatives

Building the Contingency Road Map

Detours

• Under Construction – Data Dissemination What roads are Aurora planning to travel?

1st Stop: NPI Registry

2nd Stop: NPPES Download File

Aurora Health Care

• Aurora has sites in more than 90 communities throughout eastern Wisconsin, including 13 hospitals, more than 100 clinics and 120 community pharmacies. More than 3,400 physicians are affiliated with Aurora Health Care, including more than 680 who make up Aurora Medical Group.

• Other services include laboratories, home care and hospice, quick care and more.

• 10 billing systems producing 7,000,000 claims electronically annually

The Contingency Plan Map

• Smooth Roads – Positives of Contingency Continuation of Transactions with little

disruption to cash and business process flow

Allows additional time for testing to assure appropriate transaction processing

Continue to collect NPIs for secondary providers

Gives additional time for Data Dissemination and Information Exchange

The Contingency Plan Map

• Pot Holes: Negatives of Contingency Coordinating trading partners for

varying end of contingency dates

Some felt the compliance guidance was a free pass to slow down on the NPI project

Had to address “hiccups” with NPI-related rejections with Trading Partners (I.e. Edits that were supposed to be removed)

The Contingency Plan Map

• Pot Holes: Negatives of Contingency Additional Costs – Staff who thought

the bulk of their work would be completed by May 23, 2007, is now extended:

• IS

• Project Leads

• Provider Activation

• Business Office

The Contingency Plan Map

• Building the Contingency Road Map Creating timelines for legacy id use,

dual use and NPI only use

Communicating and working with payers on contingency

Document all good faith efforts to date, and update every 2 months

Address missing NPI related information

The Contingency Plan Map

• Detours Physician Quality Reporting

Initiatives (PQRI)

Present on Admission (POA)

Updating NPI records, NPPES

Issues:• Related to Paper Claim Forms

• NPI Contingency – edits/rejections

• Remittance issues due to NPI crosswalks

Under Construction – Data Dissemination

• What roads is Aurora planning to travel? Created reports for each System

regarding:• Primary Provider’s missing NPI

• Secondary Provider’s missing NPI

Use Data Dissemination Download file for NPI verification

Gap fill missing NPIs with Download and NPI Registry

New Providers: Look-up functionality

Under Construction – Data Dissemination

• 1st Stop: NPI Registry https://nppes.cms.hhs.gov/NPPES/Welcome.do

Expected this sooner, didn’t happen until Sept. 4th

How did the data look?

What issues did we see?

Did the registry fulfill our needs?

Under Construction – Data Dissemination

• 2nd Stop: NPPES Download File http://nppesdata.cms.hhs.gov/cms_NPI_files.html

Expected this sooner, didn’t happen until Sept. 11th

Size of Files: Est. 340MB Compressed/zipped

Length of time it will take to take the file and load into our NPI DB?

Timeliness of update files: once a month

Suzanne StewartEDI Coordinator, Aurora Health Care

Milwaukee, [email protected]

414-647-3398