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The NPI Debate Heats Up

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Questionable Benefits for Providers

[By Darrell Pruitt; DDS]pruitt

I really hate lies!

Even though I have been a member of the American Dental Association [ADA] for 26 years, and intend to remain a member for the rest of my life, I cannot stand by silently any longer while my professional organization uses lies and/or deception to trick trusting members into volunteering for NPI numbers. 

Now, to see what I mean, please read what the ADA tells dentists about the benefits of the NPI number http://www.ada.org/prof/resources/topics/npi.asp

  • 1. Once implemented across the entire health care industry, the NPI will be accepted by all dental plans as a valid provider identifier on electronic dental claims and other standard electronic transactions.
  • 2. Dentists will not have to maintain multiple, arbitrary identifiers required by dental plans, nor will they have to remember which number to use with which dental plan.
  • 3. NPIs introduce an important element of standardization to electronic transactions that should improve transaction acceptance rates.   

Questionable Benefits Review

See what I mean? Now let’s review:  

  • 1. Number one clearly benefits only insurers and number three is unwashed tyranny.  The smell of sweet buzzwords counter-balancing the odor of the verb “should” immediately revealed to me traditional PR hucksterism … and I’ve seen better. The NPI number, which is conveniently necessary for electronic transactions, will only make it cheaper for insurers to deny claims.  I think anyone can see that denials will increase for natural, bottom line reasons.
  • 2. That leaves benefit number two – reduction of ID numbers – as dentists’ last hope of a return on investment in the voluntary NPI.  And, ROI could take a while.  In the first place, how much do multiple identification numbers actually slow dentistry production in a computerized dental office?  Why don’t we get silly?
  • 3. Of all things, for the ADA to list simplification as a benefit of the NPI is embarrassing, but here is what will make a few ADA leaders avoid each other in the halls of Headquarters next week. Even though the promise of simplification is lame, it is technically the only benefit the NPI number lends dentists and their patients.

Enter the AAFP

Here now, is some fresh bad-news for certain ADA leaders and members who trusted their advice. 

In an article that was posted yesterday on the American Academy of Family Physicians (AAFP) website, it looks like CMS reneged on simplification.

http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20080829keep-ptans.html

PTANS 

“Notice to physicians: Hold on to your Medicare Provider Transaction Access Numbers [PTANs], also known as legacy numbers which were to have been retired after the mandatory use of National Provider Identifier [NPI] numbers on May 23.” CMS has found another use for those old PTANs.”

Imagine that.  Instead of eliminating all of those identifiers as promised, the NPI is just one more number to add to the hard drive.

Assessment

Regardless, patients don’t suffer harm from all this, right?  Wrong. 

I’ll describe harm from HIPAA, the biggest blunder in the history of dentistry, and medicine, next time. 

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8 Responses

  1. NPI Maintenance! … Nobody said anything about maintenance?

    It is my hope that an official of the American Dental Association is reading this. A response would be wonderful, but I don’t expect it. Like all traditional institutions, it’s not part of the business model to defend actions to consumers unless a lawsuit is involved. Leaders traditionally fear consumers. And consumers are catching onto why that is so.

    Some interesting information concerning the NPI number was recently posted by North Dakota Senator Tom Seymour on his website, “Frontier Focus.”
    http://senator-tom-seymour.blogspot.com/2008/09/medicare-and-medicaid-services.html

    In his greeting to readers, Sen. Seymour thanked them for their efforts to broadcast CMS information in the region. It is followed by a list of 15 tedious CMS issues. And to think some politicians would have universal health care modeled on Medicare to save money for the common good.

    I want to focus on issue number 5, “NPPES User Maintenance Tips.”

    The National Plan and Provider Enumeration System (NPPES) is something that ADA leaders failed to explain to members – even as members were encouraged to quickly apply for the NPI by representatives from the ADA Department of Dental Informatics (healthcare IT stakeholders within the ADA). Very few of my colleagues even knew that the NPI was part of HIPAA two years ago. They are still too busy providing healthcare to pay attention… so far.

    The NPPES is all about the fourth cornerstone in Bush’s Executive Order a year ago – “Aligning incentives so payers, providers and patients benefit when all are focused on achieving the best care-value at the lowest unit-cost.” Most dentists in the US don’t know this yet, but soon, websites supported by the NPPES will allow the government and/or insurers to post dentists’ grade cards and what they think dentists should be paid. This will be done using data from dental claims already on record. It is unknown whether patients’ preferences will be included in dentists’ grades. ADA members were not told.

    It is interesting how the clever and seemingly stealthy plans for HIPAA came together. As it turns out, when one applies for an NPI number, the provider grants legal permission for FOIA-disclosable data to be posted on the Internet by stakeholders like insurance companies. (More about the “Freedom of Information Act” later) It’s not your dad’s FOIA any more. It’s been Hillary’s since 1996.

    One reason why American dentists know so little about HIPAA is because the ADA is silent. I think too many careers are pinned on a premature, stakeholder-infested plan gone bad, nation wide. It is my opinion that ADA leadership should stand up now and either defend HIPAA or abandon it. The leaders of my professional organization can no longer avoid their responsibility to keep members informed. They can’t just leave it to me. If a dentist neglects NPI maintenance, it can only mean one thing – “Payment is denied until corrections are made.” And this is just to get paid for work that happily walked out the door weeks or sometimes months before.

    How did it come to the point where in the name of interoperable fantasy, providers’ payments are held for ransom? I call that tyranny.

    Best
    Darrell K. Pruitt DDS

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  2. Let’s see what I can do from here. I’m coming across new ideas in entertainment every day.

    http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14854

    Can the ADA handle members’ questions?

    “I think dentists are becoming more aware the Association is representing their interests on regulatory issues. The people behind our Public Affairs Initiative in our governmental affairs area are always equipped to handle questions.”

    -Dr. John S. Findley
    October 2008 interview published in the ADA News.

    http://www.ada.org/members/resources/pubs/adanews/081006_findley.asp

    QUESTION

    What happens if an ADA member wants information about the NPI number that the ADA once encouraged dentists to quickly apply for?

    INVESTIGATION

    Contrary to Dr. John Findley’s promises, when I sought out people equipped to handle my questions, I ran into dead ends at ADA Headquarters. Nobody at all would talk to me about the NPI number. So I moved my investigation, which I hoped would become a pilot study, to the state associations. Below is the Texas Dental Association’s copy of an email that I sent to 42 of the 50 associations on 3/18/08. Some of the questionnaires were sent to the executive directors of the state associations, such as Mary Kay Linn of the TDA. Most were sent to non-specific contact links. (List follows in “DATA”).

    Of the remaining 8 states that did not receive a questionnaire, 6 of the state websites required registration to leave a message. I did not bother with those. Of the remaining two, Washington State Dental Association had a bad email address, as did Arkansas State Dental Association.

    I could not determine what the problem was with Washington’s address, but I have an idea about the cause of the failure of modern communication in Arkansas. To this day, if one visits the “contact” page of the Arkansas State Dental Association’s website http://www.dental-asda.org/asda1_018.htm, and click on the email link, your next outgoing email will be futilely rushed to “your@address.here” .

    Arkansas is but one of the unforeseen challenges facing our nation’s effort to achieve interoperable electronic health records.

    From: pruittdarrell [mailto:pruittdarrell@sbcglobal.net]
    Sent: Tuesday, March 18, 2008 7:39 PM
    To: ‘marykay@tda.org’
    Subject: National EHR survey – pilot study

    Dear Mary Kay Linn:

    My name is Darrell Pruitt. I practice dentistry full-time in Fort Worth, Texas. I am performing independent research on the progress of Electronic Health Record (EHR) adoption in dentistry – state by state. I request a little of your time to help me with this pilot study, consisting of only a few questions.

    In August of 2007, President Bush issued an executive order calling for the nation’s healthcare providers, including dentists, to adopt interoperable EHRs by 2014. Since the progress of adoption is not being monitored in dentistry, one has to agree that it is urgently important that our profession obtain and report the progress. That is why I am requesting your help. If precise information is available, please note source. If not, please give an estimate.

    1) What percentage of dentists in your state are HIPAA-covered entities?
    2) What percentage have NPI numbers?
    3) What percentage currently have “paperless practices,” including electronic dental records?
    4) What percentage use computers for front office duties? (checking out patients, filing insurance)
    5) What percentage file insurance claims electronically?

    Thank you for your time. If I receive a response, I will let you know the results of this study.

    Sincerely,
    Darrell Pruitt DDS
    RESULTS

    I received only one response, and it was not even from my own state association. A kind representative from California replied that the CDA does not have the information I requested, and suggested that I try the CMS.

    I discovered that CMS is not allowed to release that information. It is a national secret.

    DISCUSSION

    One of the duties of the ADA Department of Informatics is to promote the adoption of NPI numbers. Up until the NPI deadline was delayed a couple of times, the ADA vigorously promoted the number on the ADA News Online.

    What follows is a list of the articles about the NPI that have appeared in the ADA News over the last four and a half years.

    http://www.ada.org/prof/resources/topics/npi.asp

    It is interesting to note how the titles changed from optimism to despair, with the final article from over a year ago revealing a dark warning about the voluntary number. It has been a year since the ADA has mentioned anything at all:

    Feds set sights on national identifier system for health care providers (Feb. 16, 2004)
    National Provider Identifier application process begins May 23 (May 17, 2005)
    Association launches NPI information campaign (May 23, 2005)
    Doctor, who are you? (June 6, 2005)
    It’s time to apply for a national provider identifier (May 9, 2006)
    The national provider identifier (July 11, 2006)
    No need to buy NPI kits (Aug. 7, 2006)
    It’s time to get your NPI (Mar. 5, 2007)
    NPI deadline delay (April 17, 2007)
    National provider identifier posting doesn’t make personal data accessible (June 20, 2007)
    Check NPI data before it’s posted on Web (Aug. 17, 2007)

    If the numbers of US dentists who have applied for NPI numbers is a national secret as I was told, it does not make sense that the ADA Department of Dental Informatics would spend enormous efforts in recruiting dentists without being held accountable for the progress of the effort.

    CONCLUSION

    1. Dr. John Findley is mistaken.
    2. The ADA Department of Dental Informatics is not transparent with membership about its activities.
    3. Some states may need special help.

    Respectfully,
    Darrell K. Pruitt; DDS

    DATA:

    Here are the addresses I sent the questionnaire to. The asterisks note the states I was not able to reach on the Internet:

    Alabama dradental@bellsouth.net

    *Alaska http://www.akdental.org/contact.asp

    *Arizona http://www.azda.org/email/index.asp?P=10

    *Arkansas your@address.here

    California contactcda@cda.org

    Colorado info@cdaonline.org

    Connecticut cdingeldey@csda.com Carol Dingeldey

    *Delaware http://www.delawarestatedentalsociety.org/contactus.html

    Florida nwa@ij.net Dr. Nolan W. Allen

    Georgia phillips@gadental.org Martha S. Phillips, Executive Director

    Hawaii hda@hawaiidentalassociation.net

    Idaho info@isdaweb.com

    Illinois info@isds.org

    Indiana doug@indental.org Douglas M. Bush Ex.dir

    Iowa info@iowadental.org

    Kansas kevin@ksdental.org Kevin J. Robertson, CAE, Executive Director

    Kentucky info@kyda.org

    Louisiana info@ladental.org

    Maine info@medental.org

    Maryland mddent@msda.com

    Massachusetts rboose@massdental.org Robert E. Boose, EdD Executive dir.

    *Michigan http://public.smilemichigan.com/site/293/default.aspx

    Minnesota info@mndental.org

    Mississippi office@msdental.org

    Missouri vicki@modental.org Vicki Wilbers Ex.dir.

    Montana mda@mt.net

    Nebraska nda@alltel.net

    Nevada nda@lasvegas.net Robert H. Talley, D.D.S. Ex.dir.

    New Hampshire info@nhds.org

    New Jersey ameisel@njda.org Arthur Meisel, Esq Ex. Dir.

    New Mexico mmoores@nmdental.org Mark D. Moores, Executive Director

    *New York http://nysdental.org/nysda_contacts/index.cfm

    North Carolina aparker@ncdental.org M. Alec Parker, Executive Director

    North Dakota ndda@midconetwork.com JOSEPH J. CICHY Executive Director

    Ohio david@oda.org David Owsiany, JD – Executive Director

    Oklahoma ddavis@okda.org Dana Davis Executive Director

    Oregon info@oregondental.org

    Pennsylvania rvn@padental.org Rebecca Von Nieda Director of Meetings & Ad

    Rhode Island info@ridental.com

    South Carolina lathamp@scda.org Phil Latham, Ex. dir

    South Dakota info@sddental.org

    Tennessee tda@tenndental.org

    Texas marykay@tda.org Mary Kay Linn Executive Director

    *Utah uda@uda.org X bad address

    Vermont ptaylorvt@aol.com

    Virginia info@vadental.org

    *Washington rutha@wsda.org X bad address

    West Virginia wvrds@aol.com Richard D. Stevens Executive Director

    *Wisconsin http://www.wda.org/feedbacks/new

    Wyoming WYODENTAL@bresnan.net Ms. Diane O’Keefe, Executive Director

    Like

  3. BCBSTX on Twitter – Pilot Episode

    At last! Perhaps unintentionally and probably only temporarily, BCBSTX opened discussion with dentists on Twitter this weekend. Please join in with any compliments or complaints you may have collected concerning the way BCBSTX has treated you. Just so you’ll know, everyone chooses a stage name on Twitter. They call me “Proots.”

    http://twitter.com/BCBSTX

    I personally don’t think the official who signed off on this idea at BCBSTX Headquarters actually understood the accountability that comes with participation in a social platform like Twitter. I also suspect that this modern portal into the deep interior of the slow-moving organization will close soon. Here is Proots Rule number 1 – It is impossible for a command-and-control organization to be half-way transparent. Rule number 1a – Shielding PR employees with anonymity creates its own problems.

    For example: What is likely to happen if a graffiti artist with a backpack full of spray paint finds a virgin white box car on a hidden side track?

    Pilot episode: “web, TweetDeck and friends.”

    In this episode, we discover that the blank canvas provided by the anonymity of BCBSTX employees yields artistic latitude. Fill-in-the-blank characters beg for uninhibited branding – and that happens to especially appeal to my creative side. Did I mention that I’ve done some screenwriting? How about a real-time, online sitcom built around BCBSTX and its humor-packed struggle against truth in the marketplace? I intend to use both real and imaginary (all unpaid, of course) characters, depending on what fits the facts that are pried out of BCBSTX concerning the NPI number and other issues.

    For those who might complain that I am an unprofessional journalist, let me first of all say that I’ll try to be more professional if and when I ever receive pay for this … maybe. Secondly, in my defense, let me suggest that the nation is in the early stages of a recurring “wild west” in journalism comparable to the crazy wiki years following the appearance of the Gutenberg press in the fifteenth century, and again in the 1800’s – when historical events in the frontier were made much more interesting in New England newspapers by a few imaginative reporters who, like me, were left to their own imaginations to fill in the blanks. Why not? At least I’m transparent about it.

    The mix of fact and fiction by story-tellers is nothing new. It started around campfires long, long before Beowulf, and is still the basis for novels, as well as religions. As we all know, the mixture of fact with fiction is also nothing new for modern news reporters either. It’s just that according to a professional code of ethics, they aren’t supposed to get caught doing such things. The fact is, interesting stories are useful for floating otherwise vanilla facts. In my mix of fact and fiction, I hope to illustrate the as yet unrecognized power of intertwined social networks in changing the behavior of very large and politically powerful institutions, such as BCBSTX.

    This weekend, I read the 57 comments that had been posted on the BCBSTX Twitter site since it started in December. Most of the short responses were posted by “web,” who I think almost has a degree in fashion design and a few by “TweetDeck,” who I predict is web’s supervisor in the PR department of BCBSTX. I say he has a degree from Michigan State in public relations, and dropped out of a class on Internet marketing, taught by Ari Adler (a real person), who is an adjunct professor who also works for Delta Dental of Michigan. I haven’t yet decided where web is from, but I think she will be from Texas; probably Houston.

    To keep this story moving, you can see that I have taken the artistic license to develop the characters – perhaps even linking them to real people you might have met in past adventures on this forum. What are web, TweetDeck or Ari Adler going to do? Are they going to come out and shame me into to admitting that I’m wrong? We should be so lucky to be so entertained.

    I performed some light statistics to BCBSTX’s history on Twitter. Here are the results:

    In December and January, there were a total of 17 comments posted on the BCBSTX Twitter site. 47% of them were BCBSTX ads or other PR pieces, 24% were responses to visitor compliments, and one (6%) comment at the last of January was a response to a client by web – promising to personally help with the client’s BCBSTX preferred provider list: “It looks like the doctor isn’t in our network. Is there a time today we can call you? We may have some options to help.”

    In February and March, the BCBSTX Twitter site became busier with 33 comments. However in these two months, there were no compliments from visitors and only 15% of the comments were BCBSTX ads and other PR pieces. The majority of the comments, 55%, concern problems BCBSTX clients are having with their plans. More and more often, web asks them, “When is a good time to have someone call you?” Web, bless her heart, has become a handy complaint compartment for BCBSTX. I hope she is paid well.

    If as a client or provider, you have ever tried to speak to a BCBSTX representative on the phone, you understand how nice it is to find a friend like web. Here’s one of my documented experiences: On May 1, 2008, while pursuing still unanswered questions about the NPI number, I had waited two days to talk to a supervisor named Wilma Jaimes (a real person), who finished eating a juicy peach while I waited just a few minutes longer. I caught her sloppy eating habits, loose facts and more on a microcassette audio tape. With employees like Wilma, it is no surprise that BCBSTX clients are attracted by web’s personal attention.

    As one might expect, I immediately took the opportunity to submit my own question for web and/or TweetDeck. Surprisingly, after lying low for several days as complaints from customers started coming in, TweetDeck responded to my question yesterday evening:

    @BCBSTX
    “Do dentists have to have NPI numbers to use your dental insurance?”
    D. Kellus Pruitt DDS

    7:58 AM Apr 18th from web in reply to BCBSTX

    @Proots
    “I believe it is required of all, but let me check and get back to you.”
    about 11 hours ago from TweetDeck in reply to Proots

    I hope TweetDeck and Wilma Jaimes get the opportunity to meet soon. A year ago, Wilma thought the NPI number was a requirement for licensure in Texas – rookie mistake – and she’s a supervisor.

    So here’s today’s story to help fill in the blanks. TweetDeck had an emergency meeting with his boss this morning. Although I’m not sure yet what it was about, I suspect it concerns the recent developments on their Twitter site. I think TweetDeck talked someone into the idea in September, and now he is being called on the carpet. I’ll tell you more budding rumors following his response.

    Stay tuned, and whatever you do, don’t tell BCBSTX about this or they’ll shut their Twitter site down before we’re through with the first season.

    D. Kellus Pruitt; DDS

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  4. BCBSTX and Twitter 4.22.09‏

    Episode 1 – Routine Delay

    Delay is business as usual for slow-movers like BCBSTX, and don’t expect modern communications to speed them up much, if at all.

    As I mentioned before, when I called BCBSTX a year ago to ask about their NPI policy, it was two days before I was able to speak to a supervisor with the authority to answer my questions over the phone. Her name is Wilma Jaimes. From the four day (and counting) delay in a response from TweetDeck on the BCBSTX Twitter site, it appears that in the last 12 months, the Internet has not improved BCBSTX’s notoriously slow reaction time. BCBSTX provides us with classical, archetypal humor based on self-deceiving arrogance – a perfect sitcom platform.

    “Companies need to realize their markets are often laughing. At them” – Thesis number 20, “The Cluetrain Manifesto,” written by Levine, Locke, Searls and Weinberger.

    As I pointed out earlier, one or more boneheads in leadership positions at BCBSTX should have realized that no social network is designed to accommodate command-and-control PR plans. It is oh so well known in the blogosphere that the marketplace described nine years ago in Thesis number 20 can be a cold and lonely place where bad things publicly happen to deception in entertaining ways.

    I think what I am trying to explain is succinctly described in a paragraph from the opening of Chapter 10 of “Naked Conversations” – a book about blogging published three years ago, written by Robert Scoble and Shel Israel. The title of the chapter is “Doing It Wrong.”

    “One simple rule for doing it right is be real. If you are going to blog, be authentic. Keep your conversations naked. Let people know who you are and where you are coming from. If you don’t, blogger vigilantes will forum torch-lit mobs to expose your false or character blog, and they will continue their assault until they have driven a stake through the heart of your deception. There may be no rulebook or designated enforcement squads, but the blogosphere is filled with members committed to keeping it a ‘clean channel,’ unadulterated by clever, cute, or contrived entries.”

    Get a stake

    I just searched “BCBSTX” on Google, and not only is the caustic comment on the PennWell forum, “Why the long NPI, BCBSTX?” on their first page, but the BCBSTX Twitter site is their fifth hit. It featuresTweetDeck’s reply to me from two days ago, promising to answer the still unanswered question about how NPI number affects their clients’ dental insurance policies.

    A couple of years ago, BCBSTX began publishing a junk-mail piece titled “NPI Times” to promote the adoption of NPI numbers by dentists in Texas. Lots of healthcare dollars were spent, not to actually provide healthcare, but to publish and mail “NPI Times” – a four-page, professional-quality monthly newsletter that celebrates a part of HIPAA. Is it any wonder why Americans receive so little for the money they spend on BCBSTX insurance when their advertising budget includes the needs of the US government? And that is a needy bunch.

    I find it strange that in the last year, BCBSTX employees have learned so very little about the identification number they promote. Let me show how their path to knowledge began.

    Flashback

    The history described below is drawn from an email blast, April 29, 2008:

    BCBSTX threatens to break contracts with Tarrant county employers

    I received my NPI Times April 2008 edition today from BCBSTX. They are once again warning me that if I don’t get an NPI number, a couple of local employers who paid BCBSTX for dental insurance will have wasted their money. It appears that BCBSTX intends to break contracts over the NPI number. That takes courage. I say go for it, Blue.

    I think the Texas Insurance Commission should know about this. Maybe the Attorney General should also be informed. If anyone is interested, I have the hard evidence, and more is on the way if a supervisor from BCBSTX calls me back tomorrow. This is exciting.

    After glancing through the NPI Times, I called the BCBSTX number provided and asked what I should tell their clients who pay me for my treatment in full at the time of service. I recorded the conversations. Be my guest. Please listen in. If I should digitize the recording, I’ll share that with you as well some day.

    After a few minutes of automatic telephone routing I found myself speaking to a human. She asked me for a BCBS identification number. I replied, “I don’t have a contract with BCBSTX, but I have a question about the NPI number.”

    The BCBSTX representative named Amber replied cheerily, “And what can I help you with?”

    “I don’t plan to get one, and I have patients that have BCBSTX insurance who know that they are going to have to pay at the time of the visit because you have stated that you will not process claims without an NPI number. And so they are going to ask me whether their insurance is worth anything or not. And of course, when they can’t do anything with it I am going to have to tell them that if their insurance isn’t paying, it’s not my fault.”

    (long pause)

    I resumed, “You see what I’m saying?”

    Amber replied, “I do see what you are saying. Ys.”

    “So what should I tell my patients when they come in and pay me for services? Should I tell them to file the claim themselves?”

    “I would be concerned though that even if they filed the claims themselves and list you as the rendering provider we might run into the same problem…”

    “And then you would have a problem with your client, but you wouldn’t have a problem with me.”

    Amber said, “Right. It would be more between us and our members, but since you are the rendering provider it would still involve you in a way.”

    “In what way?”

    “Only because they are actually submitting you as the dentist doing the services and we simply cannot process the claim without having that NPI number on file. I’m just wondering if there is any way we can get around that, especially since it is reimbursing the actual patient.”

    “Yea. Well that, I think, is your problem, but not my problem. Right?”

    Amber said, “That would be something that would involve us, but the fact that you are the dentist doing the services and you are not interested in obtaining the NPI number I mean… That does complicate matters a little bit for…”

    I break in, “It complicates matters for you” (no response). “Then, can tell my patients that Blue Cross Blue Shield will honor their insurance, even though I don’t have an NPI number. Is that right?”

    “Not necessarily. Let me check and see if there is anything we can do because I don’t want them to have problems because it is not their fault …”

    “And it’s not my fault,” I quickly added.

    “That’s up to you if you don’t want to get the NPI number.”

    “Right”

    “If you don’t mind holding for a second, let me talk to my supervisor and see if she has anything we can at least tell your patients that would help them out.”

    “That would be great.”

    After several minutes the BCBSTX representative came back on the line. “If it’s alright with you, rather than waste your time keeping you on hold – my technician is actually talking with Provider Relations for you …”

    “OK! That’s great …”

    “I don’t have a definite answer just because we have not come across this before…”

    “I can’t believe that”; I chuckle. She chuckles as well. “That’s incredible.”

    “If it’s alright with you, let us investigate and see if we can at least give you something that you can tell your patients, see if we can work with you in some way on this.”

    “Well, my bottom line is, my patients will pay for my service at the time I provide it and you can deal with your client. That’s the bottom line. Let me know what you want me to tell your client.”

    “OK. That will be fine. I will speak with you as soon as I get an answer.”

    “Thank you.”

    “Have a good day.”

    An hour or so later I received a phone call from BCBSTX.

    “Hello, Dr. Pruitt. My name is Joanie and I am the technician on the floor here today at Blue Cross Blue Shield of Texas.”

    “Right”

    “You talked a little bit ago with one of our representatives about the NPI number?”

    “Right”

    “I checked with our provider unit, and the NPI number is not a BCBS requirement. It is a national requirement by the American Dental Association.”

    “Wait a minute. The American Dental Association is not a lawmaking body.”

    “OK. But the NPI number is being mandated because of the HIPAA regulation.” (She hesitates) “I mean it’s a federal …“

    I cut in, “It only covers people who transmit electronically.”

    (Silence)

    I whisper to Joanie, “Do you not know that?”

    She stammers, “OK it’s not…”

    I repeat my question a little louder and incredulously. “Do you not know that?” Now I am giggling.

    Joanie becomes defensive. “There will be a time when no claims will be processed without an NPI number. I mean it won’t be immediately, but in the future, you will need an NPI number.”

    “I’ll deal with it in the future.”

    “OK,” she tells me in a dismissive tone.

    (a pause)

    “Now, what I have a question about is this. Your clients are going to come into my office and they are going to ask me ‘What do I do about my insurance?’ because they are going to pay me. What do you want me to tell them?”

    “They can submit their claims, but they may be rejected for not being able to cover them because you do not have an NPI number.”

    “So I can call my patients right now and tell them that their insurance is not worth paying for?”

    “The claims may be rejected if you do not have an NPI number.”

    “Dear Sir. I have just been informed by Joanie at Blue Cross Blue Shield that your insurance is not good in my office.”

    “That is not what I am saying.”

    “OK. What are you saying then? How do you want me to word this letter?”

    “OK. I think I will have my supervisor call you back tomorrow.”

    “That’ll work.”

    “Alright?”

    “Thank (click) … you.”

    I’ll let you know what happened on April 30, 2008 in the next episode. Maybe TweetDeck will have responded by then.

    D. Kellus Pruitt: DDS

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  5. Will BCBSTX overcome stage fright?

    I apologize for the delay in sharing Episode 2 of “web, TweetDeck and friends.” Since I am depending on reluctant and unpaid actors in this real-time reality sitcom, the pace of the story – a contemporary milestone in dark humor or, if one is a BCBSTX fan, a classical tragedy that we already know will not end well – is understandably out of my control. In an effort to keep the plot moving forward to what promises to be a dramatic conclusion, this morning I sent TweetDeck an edgy follow-up to my earlier question about BCBSTX’s NPI policy.

    “@ BCBSTX Six days, no answer. I have no NPI number. Can BCBSTX clients use their dental insurance in my practice?”
    “Simple question.”
    6:20 AM Apr 25th from web in reply to BCBSTX

    If you recall, in the first episode, Sidney “TweetDeck” Jones, a ladies’ man and recurrent hairclub for men member, promised to get back to me. Does anyone else find it interesting that the old-fashioned telephone, including all the routine BCBSTX routing, misconnections and juicy peaches is faster than the Internet for providers who need to speak with a BCBSTX representative on behalf of BCBSTX clients’ financial interests? Sometimes technology is wasted on slow-thinking boneheads.

    Regarding my conversations with Amber, Joanie and Wilma that occurred a year ago, I wish to take this opportunity to point out a couple of discrepancies that might otherwise go unnoticed and unappreciated in the PennWell Community Theater. I assume readers have figured out by now that some BCBSTX employees, including a floor technician, a supervisor and one “over-all” supervisor, cannot keep their stories straight concerning basic information about the NPI number. It’s fun to watch their impromptu sketches. Like Second City veterans, they portray their characters so close to the vest, yet so transparently.

    The simple question, “Why should I get an NPI number?” is a magic nidus for free-falling chunks of imaginative reasoning from virtually anywhere in the dental benefits industry. The NPI is a lot like the HIPAA Rule – it can be whatever one needs it to be. The inevitable result of such laws reminds me of a frantic, unanimous, show-of-hands vote (following extensive and desperate lobbying) for an immediate emergency just-this-one-time-I-promise lifting of the campus rule against sex in the dorm at Texas Tech University on a beautiful spring afternoon in the mid-1970s …

    A few months before BCBSTX floor technicians were telling dentists that they are forced to get NPI numbers by an ADA law. Delta Dental representatives at their booth at the Southwest Dental Conference in Dallas assured me that the NPI numbers will soon be required for state licensure. They’re such comedians. You got to love ‘em.

    One more thing, and then I’ll leave you alone. I promise.

    In Episode 1, I asked Amber how I should tell her clients that their BCBSTX insurance is worthless in my office. After wrestling for a few minutes over who actually owns the NPI problem, and coming to a draw, she finally said, “If it’s alright with you, rather than waste your time keeping you on hold – my technician is actually talking with Provider Relations for you …”

    I responded, “OK! That’s great…”

    “I don’t have a definite answer just because we have not come across this before …”

    “I can’t believe that.” I chuckle. She chuckles as well. “That’s incredible.”

    Now let’s move forward in history a few weeks to late May, 2008. This is when BCBSTX’s NPI policy began causing its intended, tyrannical effect on my practice, as well as when the clock started clicking on harm caused to my patients by the fat, insensitive insurance giant with lots of assets. At the slight risk of gathering a crowd with lynch on their minds, I bet there are BCBSTX clients all over Texas who have been forced out of comfortable dental homes by BCBSTX’s NPI policy. When one considers that continuity of oral care is arguably the single cheapest and most effective protection from the ravages of very expensive chronic diseases such as diabetes, one might conclude that several thousand borderline-diabetic Texans might have grounds for a class-action lawsuit. I don’t know. I’m just the piccolo player.

    I have to say that I’ve seen stranger things happen. So if anyone should ask, I would love to testify for the plaintiffs. Just let me know who you want me to start messing with. I work for a fee a little cheaper than fair. I easily undercut Karl Rove on everything but ethics. Nobody can sell out like the Rover.

    Because BCBSTX began rejecting my patients’ claims for lack of an NPI number, as they promised they would, I not only lost patients who had been with me for decades, but I also lost untold numbers of potential patients who had been intentionally misled into thinking that their dental insurance could be used at any dentist office of their choice in the state of Texas. My office manager continues to explain BCBSTX’s tricky NPI policy to their clients who invariably go somewhere else to have their work done. As one can imagine, in a small office, it is difficult to avoid expenses caused by BCBSTX confusion, and still maintain the professional generosity to provide their clients the information necessary to make informed decisions about dental treatment options and available providers. To give away this thankless community service requires ethics – especially when an actual patient is holding on the second of two lines, ready to make an appointment. There is a lot of meaningless expense built into healthcare today, and as far as I can tell, 40% of wasted dollars is BCBSTX’s fault.

    On July 7, I co-received another letter with yet another patient saying that BCBSTX could not process the dental claim that Molly already paid for in full, because I do not have an NPI number. Molly’s case was one of the last times I attempted to intercede on patients’ behalf to try to get BCBSTX to pay them what they are legally due. After playing the same version of the game “1-800-BCBSTX whack-a-mole” on the keyboard of my phone, I easily qualified to talk to a human on the first try. Then I trudged through the member identification fill-in-the-blank level. Finally, I was allowed to politely ask my new, precious friend for the alpha-numerical consultant (no name given) listed next to the 1-800 number featured on Molly’s BCBSTX denial of coverage letter. In the end, when I finally spoke to WSn45582 (plus or minus), the effort turned out to be a frustration for me, BCBSTX and Molly. However, the serendipitous conversation with a patient and kind BCBSTX employee to whom I was misdirected only started off boring: “No, I do not have a member identification number,” and “I simply have a question about the NPI number, and ….” When the rep told me that she could not answer my question, I temporarily lost my sense of appreciation. At the risk of being set back to another round of qualification tests, I failed to cover my impatience when I demanded, “Why was I given this phone number?”

    The rep calmly replied: “I think she typed the wrong number into her letter … And I apologize. We’ve been having to do so many letters it is not funny.”

    “On this NPI thing?”

    “Oh yeah!”

    I immediately fell in love again with a now-forgotten alpha-numeric I met by chance.

    I hope that was worth your patience. Only five weeks before being told that there were problems with the NPI thing at BCBSTX by my sweetheart, Amber said that she couldn’t answer my NPI question simply because I was the first dentist to bring up a problem with the NPI number. I told Amber that I thought her statement was incredible and we both chuckled.

    D. Kellus Pruitt; DDS

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  6. Dr. Pruitt,

    As you know, physicians NPI numbers are sometimes referred to as doctor’s NPI numbers, and are required to process many forms regarding payment from Medicare and other agencies; particularly health insurance companies.

    So, here is a link I just found. I don’t know how accurate it is, but pass it along FYI.

    Link: http://www.npinumbers.org

    Amy

    Like

  7. Thanks, Amy.

    I suspect that you missed the point of my argument against the NPI number due to CMS’s successful PR blitz a few years ago that included clever insurance lobbyists and colorful ads. Lots of the smartest doctors in the nation were tricked as well. They were also assured that the time-saving NPI number is completely harmless as they were rushed into signing up for them. Looking back on this example of American transparency, doesn’t it seem odd that even though the number is voluntary, it is irreversible?

    I watched the movie “Idiocracy” with my son this weekend. The premise of the futuristic Mike Judge comedy is that over the next 500 years, the breeding success of slow-thinkers outpaces the smarter pool of genes and eventually selects for a society of gullible citizens beyond the reach of normal reasoning capacity. The result is a corporate-heavy world of mounting environmental problems such as garbage avalanches and ground that won’t grow crops.

    So what happened to the fertility of the soil? Guided by colorful ads similar to those the CMS purchased for the NPI, our progeny are predicted to irrigate with a popular brand of sports drink because its owners successfully lobbied to have all crops fed its corporate product rather than water. When questioned about this, a slow-thinker named Frito defends the liberal use of the green fluid by repeating the PR talking point: “It’s got ‘lectrolytes.”

    And you know all those other numbers an’ stuff that are hard for doctors to remember? The NPI ‘liminates ‘em.

    D. Kellus Pruitt; DDS

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  8. PTWA censors D. Kellus Pruitt DDS – Rookie mistake

    I detest unexplained censorship by cowards like the anonymous employee of The Washington State Chapter of the American Physical Therapy Association (PTWA) – even when I’m in a charitable mood.

    When invited, I get even. And I really, really enjoy getting even.

    The PTWA sponsors a very professional-looking, well-kept blog called “This Just In.” That is where I caught the bureaucrats not only promoting the NPI number, but also protecting it from scrutiny – using censorship (badly) in the land of the free. I find it thrilling that there are still a few slow-moving dinosaurs like the PTWA to run down – just for grins – when invited.

    Seriously, why do physical therapists in the state of Washington unquestioningly let their PTWA leaders determine what members shouldn’t be allowed to read? And why do PTWA members allow their leaders to choose a government mandate over their patients’ interests? Do physical therapists in Washington abide by the Hippocratic Oath? (I think Gingrich-friendly funding trumped common sense).

    The unaccountable, command-and-control PTWA leadership with photogenic officers is a good example of what is wrong with self-serving, non-profit healthcare organizations in the US – for dentistry as well as physical therapy. I just wish I could share the employee’s name with everyone. I consider it my duty to assist shy authoritarians with their search engine optimization – just like I’ve assisted American Dental Association President Dr. Ron Tankersley and Executive Director Kathleen O’Loughlin – as well as Delta Dental’s highest officers Kim E. Volk and Dr. Thomas Fleszar. If I knew the naïve PTWA employee’s name, I could deeply brand him or her instead of “PTWA.” Like Tankersley, O’Loughlin, Volk and Fleszar, in a couple of days, this article will appear on the first page when one googles “PTWA.” And considering the weakness of “PTWA” as a keyword, I predict I’ll own their first page for a year or so.

    Here is what I posted on the PTWA blog today in response to being censored. Enjoy.

    —————————————–

    Dear “This Just In”:

    It always attracts my attention when anonymous moderators censor criticism of the NPI number – without explanation or warning. So who are you protecting, Anonymous? It certainly isn’t physical therapy patients.

    Today, your “New news and top-drawer thoughts from your chapter office” featured an article titled “It’s Time to Test the ProviderOne System.” (no byline)

    http://ptwa.wordpress.com/2010/02/08/its-time-to-test-the-providerone-system/

    “Recent testing with providers shows that most are not ready for the new ProviderOne billing requirements, which Washington’s Medicaid program plans to implement in April. To help providers prepare for the new system, Washington State Department of Social and Health Services pursued and received unprecedented federal funding to support a testing phase and a live help desk to assist providers with the transition.”

    “…pursued and received unprecedented federal funding to support a testing phase ..

    That certainly explains why you don’t allow PTWA members to read the truth about the NPI number. Your bosses are invested in the idea, just like the leaders of my American Dental Association. So how much of the unprecedented federal funding will the Washington Chapter pursue and receive? The ADA leaders made off like bandits. They built an entire Department of Dental Informatics – completely on government grants without using any dues money at all. Understandably, just like the Washington Chapter, the ADA also doesn’t allow discussion of the NPI number. Did Newt Gingrich visit your organization as well? He’s smooth!

    Let’s look at your mission statement to see how far it’s migrated: “PTWA is the Washington State Chapter of the American Physical Therapy Association. Our mission is to advance the physical therapy profession in the state of Washington through compassion, accountability, representation and excellence.”

    Where is your accountability, anonymous moderator? Where is your representation and excellence? Were these ideals your goals, or does the PTWA just use pretty words because they sound “professional”?

    This isn’t over, Anonymous. I say your “go along and get along” attitude is exactly what is wrong with the nation’s healthcare, and I intend to make an example of you so that others won’t try the same childish games.

    If you can’t take the truth, you shouldn’t be in healthcare. You should stick with politics.

    D. Kellus Pruitt; DDS

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