The NPI and One DDS’s Opinion

A Dentist Offers his View on the NPI Deadline Issue

pruitt

By Darrell Pruitt, DDS

I have a unique perspective of the National Provider Identifier [NPI] issue. 

As a dentist who has no contracts with any insurance company, I refuse to apply for an NPI number. Legally, I am not compelled to “volunteer” for the number, regardless of whether it is a mandate or not.  HHS does not license dentists. States do. Texas says that it is fine by them for me to practice here on the east side of Fort Worth.

Why Volunteer?

Why should I volunteer for the NPI mess?

The NPI does nothing to improve the quality of care I provide. It benefits only payers, and any time anyone fouls up at National Plan & Provider Enumeration System [NPPES], it can only mean one thing – payments will be delayed, earning insurers even more interest on money meant to pay for work already done and long gone out the door.

I should remind you that inflation is due to soar soon as well, making the reimbursement worth even less to the provider the longer it is delayed.

The IRS

And, there is more.

I assume you heard about the IRS sticking their fat fingers into the pie. That happened just recently, completely unexpectedly.

Now the IRS can delay claims as well if one has an NPI number. What a mess. Why would I want to be part of it? If having an NPI forces me to raise my fees, it hurts my patients.

Part of the Hippocratic Oath is to do no harm. It is clearly unethical for a doctor to have an NPI number. Allow me to show you how far ethics will take a Texas dentist these days.

My Situation

Since I am not on any managed care plans, my BCBSTX-covered dental patients who I have treated for years did not pick me off of BCBSTX’s annual preferred provider list. They chose my practice as a consistent dental home, year after year, because they were more than likely referred by a satisfied patient.

When the BCBSTX agents sold my patients’ employers their dental plans, the insured was told to tell employees that they could see any dentist they choose. This is called a traditional indemnity plan, which honors freedom of choice as opposed to the cheaper managed care plans that penalize clients for not going to dentists that the insurance company prefers.

The Managed Care Misnomer

Calling managed care in dentistry “insurance” is a misnomer. It is actually nothing more than a discount dental brokerage service with annual lists of the lowest bidders in the market, and there is no quality control.

Until recently, I have had an unwritten agreement with BCBSTX that I would honor their insurance by allowing their clients to pay only their estimated part of the dental bills, and I would wait for BCBSTX’s share to come later in the mail – however long that takes.

That is called “accepting assignment,” and it is based on trust between dentists and BCBSTX, and is a favor to patients, not a requirement.

I have to say that BCBSTX is so slow at paying their part of their clients’ bills that patients would soon become very impatient if they had to wait as long for their money as I have to wait for mine. My practice, as well as my patience, can tolerate delays … up to a point.

In the end, if a claim is unreasonably delayed by an insurer, I can ultimately call on the state insurance commission to fight for fairness for my patient. Who can I complain to if payment is delayed by the IRS?

Assessment

In the last week, BCBSTX rejected three of my claims because I don’t have an NPI.  What am I to do?  

Ultimately, I may have to go against my own ethics and apply for an NPI number in order to stay in business.

The NPI does nothing to improve the quality of care I provide to my patients. It only delays payment.

Conclusion

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