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Victory at Last
[By Darrell K. Pruitt; DDS]
Every now and then, I enjoy little victories. My war with BCBS-TX started when they began declining to pay their clients’ claims if they originated in my office. Since I’m not a HIPAA-covered entity, I didn’t volunteer for an arbitrary National Provider Identification number.
The behemoth insurance company not only successfully drove away some of my long term patients, but their clever policy blocked my access to their pool of clients who were led to believe their dental insurance was good everywhere – until my office manager had to tell them otherwise. BCBSTX is a sleazy company simply because it lies to its clients as policy.
Successful Claims
In the last two weeks, my office manager has successfully filed a couple of claims and it appears that unless payment is blocked in the next day or so, BCBSTX no longer requires Texas dentists to have NPI numbers.
Asessment
That’s nice, but I want more. I want the state CHIP program to drop its NPI requirement as well. Why limit access to dental care to the poor because of a number that only helps insurers. I’m just getting started, Texas.
Conclusion
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Filed under: Health Insurance, Health Law & Policy, Information Technology, Managed Care, Pruitt's Platform | Tagged: BCBSTX, Darrell Pruitt, DDS, dentists, health insurance claims, HIPAA, National Provider Identification number, NPI, Texas CHIP |
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NEWS BRIEF: Breach notification and BCBSTX’s NPI policy change
There are two pieces of news that popped up this morning which may interest ME-P readers. I’ll write more about them later.
At the moment, I am busy on Facebook, describing artist David Hockney’s theory of how Johannes Vermeer used optics to paint “Milkmaid” (c. 1680). Did you know that Vermeer’s neighbor and executor of his will was Van Leeuwenhoek – the great lensmaker? Do you think in his effort to achieve near-photographic realism, Vermeer might have cheated? Gasp!
As you can imagine, sometimes I also grow weary of rants about things like data breaches and the NPI number. I’ve recently discovered that renewing old friendships on Facebook is even more satisfying than telling national leaders, “You see? I told you so, Dumbass.”
News story number 1:
“HHS guts health-care breach notification law, groups warn,” was written by Jaikumar Vijayan and posted on CompurterWorld a few hours ago.
http://www.computerworld.com/s/article/9138220/HHS_guts_health_care_breach_notification_law_groups_warn?taxonomyId=1&pageNumber=1
It looks like because of laws hidden in HITECH, in the event of a breach, dentists are no longer obligated to notify anyone as long as the dentist determines that it is unlikely that the fumbled PHI will be used for malevolent purposes. Informing patients of the threat to their welfare is now at the dentist’s discretion. I suppose that means we are off the hook and everything’s going to work out just swell.
New story number 2
A family of four who had been patients of mine for many years was forced to switch to BCBSTX dental plan, which up until two weeks ago, would not process my claims because I don’t have an NPI number. The wife told me she talked to a BCBSTX representative yesterday and was told that dentists who file paper records are no longer required to have NPI numbers. They are elated that they can return to my practice. I am elated to welcome them back.
I lost many patients because I held out against an unfair business policy. It hurt me. It’s nice that some are returning. It’s been a long, hard fight from which I will never fully recover.
D. Kellus Pruitt; DDS
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Hi Darrell,
Forget about NPI numbers for doctors, SSNs and other patient identifiers. CNN recently published a story about patient ID thru iris scanning. We’ve known about biometric security technologies for years, but for some reason, it hasn’t quite taken off in healthcare.
http://www.cnn.com/2010/HEALTH/03/15/bronx.clinic.iris.scan/
So, here is a case study for a safety-net clinic in New York City’s impoverished South Bronx. It may be useful for dentists, too.
Jane
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Interesting writing
I am thankful for the details! Does anyone know where I might be able to find a template TX TXW0943 document to complete?
Roxanne Dimacale
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