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More on NPI Numbers
[By D. Kellus Pruitt DDS]
Dear Past TDA Board Members
I have some questions similar to the ones that got me suspended from the TDA a year ago: Who among you can defend your decision to persuade trusting TDA members to volunteer for National Provider Identifier (NPI) numbers?
And, why did you give up on the effort while BCBSTX continues to unfairly force dentists who aren’t even HIPAA covered entities to adopt the identifiers?
If you’re still unaware that everyone can see TDA leaders allowed themselves to be manipulated by stakeholders like BCBSTX, prepare yourself. It won’t be long before at least a few TDA members blame you personally for the bad things I warned would come to dentists with NPI numbers. Since the identifier does nothing to improve the quality of care, its promotion cannot be reconciled with the mission statement of the TDA, leaders. I hope angry dentists throughout the state seek the names of those of you who misled them.
A Non-Profit
BCBSTX is a non-profit whose handsome profits are paid by taxpayers. The healthcare parasite sells dental insurance to theUSgovernment for federal employees. In their letter to me that I’ve attached, you can see for yourself that along with BCBSTX’s stated refusal to process any of their clients’ dental claims that come from my office, it says in capital letters, “DO NOT FORWARD THIS NOTIFICATION TO THE MEMBER!” How proud does it make you feel to know BCBSTX defines your level of ethics, TDA Board? Two years ago, your Director of Membership censored from the TDA Facebook this dentist’s criticism of BCBSTX’s NPI demands. Sometimes, you bozos are idiots.
I have no contractual relationship with BCBSTX, so as soon as could, I defied BCBSTX’s order and sent their client the letter – making sure to point out that BCBSTX ordered me to keep it secret from her. As you might expect, she’s pissed at BCBSTX! I hope she looks into a class action lawsuit. I bet BCBSTX has been secretly extorting their customers’ dentists by the thousands … but then, do you even care, TDA? What did BCBSTX offer the TDA that caused you to betray dentists and patients who used to have faith in your honesty?
BCBSTX is a Tyrant, and the TDA is an Enabler
There’s more: As a favor to our patients, my office has traditionally called their insurers for coverage information so that those who purchased the dental benefits will know how much of the bill they are responsible for before we start treatment. It’s called transparency.
Today, my office manager informed me that according to alerts she has received from insurers, if I don’t “volunteer” for a National Provider Identifier (NPI) number by 2012, my office will be deprived of the right to product information about BCBSTX’s plans. How does that help anyone, TDA?
Assessment
Were you aware that this was the purpose of the NPI number when you pushed TDA members to sign up? Do you even care? Because of your silence inTexas’ dental community, it’s really hard to tell.
Conclusion
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Filed under: Health Law & Policy, Information Technology, Pruitt's Platform | Tagged: ADA, BCBSTX, D. Kellus Pruitt, HIPAA, National Provider Identifier, NPI, TDA |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Stoppibng TDA Rudeness
Once employees know they won’t be held accountable for being rude to customers, some will accept the perk and spread their rotten attitude throughout the organization. Remember Dell Computer before Jeff Jarvis’ Dell Hell?
A year ago, because the Texas Dental Association failed to respond to a $200 refund complaint, the Austin Better Business Bureau downgraded their reliability rating from an A+ to a B+. Just like the TDA’s size and legacy failed to shield the business from even one dissatisfied customer in the eyes of the BBB, it’s up to each of us as individuals to make certain that NO business in the US can ever afford to treat us with disrespect – not even the slow-learning TDA.
A few weeks ago, Linkedin suggested that according to our mutual interests, I should perhaps ask to join the TDA’s Linkedin group. Since I am not a TDA member, I became both intrigued and excited that they would send out such invitations and naturally requested to join.
No response.
A few days later, I asked again. Still nothing. So on Monday, I did what all Americans should do when anonymous employees choose to treat customers rudely – even employees of traditionally respected institutions such as the TDA: I simply demanded to speak with a supervisor.
After not hearing a thing from the TDA in two days, I returned to their Linkedin site and discovered that I am no longer allowed to even send messages to the anonymous moderator! Is that the exemplary business ethics one should expect from a professional organization that represents patients’ interests in front of lawmakers? It’s adults acting like children.
If a Wal-Mart employee treats a customer badly and the customer requests to speak to the employee’s supervisor, the employee isn’t given the option of bum-rushing the customer out the door. Far from it. Wal-Mart officials wisely recognize the need to be immediately informed of problems in the front of the store.
Do you suppose the name badges make Wal-Mart employees more accountable than TDA employees?
D. Kellus Pruitt DDS
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BCBSTX demands NPI
I lost another BCBSTX patient today.
Days ago, when my office manager scheduled today’s first appointment, if she had known that the patient is a federal employee with BCBSTX insurance, she would have warned yet another clueless BCBSTX client about their insurer’s secret NPI policy. Then, the client would have looked for a dentist who has an arbitrary NPI number and our time wouldn’t have been wasted by BCBSTX policy tyrants who cannot be held accountable for interfering with others’ schedules.
BCBSTX has re-introduced an NPI requirement it gave up on a couple of years ago – again leaving it to me and my staff to ethically inform federal employees that even though they would choose me as their dentist, BCBSTX will not reimburse me. What’s more, even if BCBSTX clients pay my fees in full, BCBSTX will still pocket the reimbursement and fund executive bonuses. Could that be called a fraudulent waste of taxpayer money by an nonprofit?
One might mistake me for a whistleblower, Congressman Cornyn. But who needs the harassment well-meaning “official” whistleblowers endure these days? BCBSTX salespeople waste enough of my time.
I posted this question on the BCBSTX Facebook: “BCBSTX, since I’m not a HIPAA covered entity, I’m not required by federal law to obtain an NPI number. Yet my office manager says she was told by a BCBSTX employee that your clients’ dental claims submitted without NPI numbers will be ignored. Is that true?”
https://www.facebook.com/bluecrossblueshieldoftexas
My Texas dental license isn’t good enough for discount dentistry broker BCBSTX. I must also have a federal NPI number or they will not process their dental claims from my office. Yet they never warn their clients about the NPI restriction – which undoubtedly results in furious clients and windfall profit for BCBSTX. Apart from being an unfair business practice that harms dentists, isn’t it against state law for insurers to mislead their clients like that, Attorney General Gregg Abbott?
I’ve come to the conclusion that since the HIPAA mandated NPI number does nothing to improve the quality or lower the cost of dental care, BCBSTX intends to use the mandate to force dentists to file claims electronically – saving BCBSTX money even if it unnecessarily risks data breaches of their clients’/my patients’ identities. And over the objections of concerned dentists on Hippocratic grounds.
Where’s the transparency, BCBSTX?
Insensitive BCBSTX executives sure messed up the morning for this dentist and a federal employee by keeping their NPI requirement a secret from those who purchase the plans. She took off work needlessly, and I needlessly held an hour of my day open for her that I could have gainfully used to treat another patient whose insurance doesn’t profit from surprise exclusions. BCBSTX’s bad manners in my community wastes federal healthcare dollars, but don’t you dare call me a whistleblower.
The ethics in my small business is much different than anonymous and unaccountable BCBSTX executives’. We never hide from our customers. What’s more, we try our best to help our customers to make informed decisions – even when honesty costs us open appointments and lost income.
It’s been 5 hours, and so far, BCBSTX has not responded to my question. How many follow-up questions do you think I can post before an anonymous BCBSTX employee kicks me off their Facebook?
Let’s find out.
D. Kellus Pruitt DDS
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BCBSTX responds
If you recall, yesterday, after losing another new patient to BlueCross BlueShield of Texas’ capricious NPI requirement, I posted the following question on the BCBSTX Facebook:
https://www.facebook.com/bluecrossblueshieldoftexas
“BCBSTX, since I’m not a HIPAA covered entity, I’m not required by federal law to obtain an NPI number. Yet my office manager says she was told by a BCBSTX employee that your clients’ dental claims submitted without NPI numbers will be ignored. Is that true?”
This morning, an anonymous BCBSTX employee replied:
“Dr. Pruitt – The NPI page on the CMS website provides the regulations and standards. Here’s the direct link: http://www.cms.gov/NationalProvIdentStand/ .“
… And the conversation blossomed:
“I didn’t ask a thing about CMS. I asked about BCBSTX policy. If your clients visit dentists who do not have NPI numbers, is their BCBSTX insurance worthless? It’s a simple question, but CMS won’t have a clue.
Let me make it easier for you. “What do you tell your clients about the NPI requirement?”
This could be fun.
Darrell K. Pruitt DDS
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HB # 300 increases the cost of dentistry in Texas
Texas dentists, have you read the details of Texas House Bill 300 which takes effect in September? Probably not. It’s frightening.
Some time ago, the widely-recognized law firm Nixon Peabody LLP became interested in Texas’ new law. On July 21, 2011, Nixon Peabody posted the advertisement “New Texas health care privacy law more stringent than HIPAA” on their website – written by law firm members Linn Freedman and Christopher Browning.
Click to access HIPAA_Alert_07_21_2011.pdf
“Texas House Bill 300 (HB 300), recently signed into law by Governor Rick Perry, mandates new patient privacy protections and harsher penalties for privacy violations related to electronic health records (EHR). The requirements of the Texas law are more stringent than those of its federal counterpart, the Health Insurance Portability and Accountability Act (“HIPAA”).”
Following Freedman and Browning’s foreshadowing of bad news for most providers and patients in Texas, is a description of the HB 300 training requirements that dentists with EHRs are expected to provide staff (quietly funded by the dentists’ clueless patients in higher fees):
– Covered entities must provide customized employee training regarding the maintenance and protection of electronic protected health information (PHI).
– CEs must provide customized employee training regarding the maintenance and protection of electronic PHI.
– CEs are required to tailor the employee training to reflect the nature of the CE’s operations and each
employee’s scope of employment as they relate to the maintenance and protection of PHI.
– New employees must complete the training within 60 days of hire.
– All employees must complete training at least once every two years.
– CEs must maintain training attendance records for all employees.
From this list, how many non-productive staff hours of training do you think are required for a dental practice to become audit-proof in Texas? Believe it or not, I’m the only dentist in the nation who questions the cost of security for electronic dental records. How secure does that make you feel? Security in dentistry simply isn’t a very active business. Not yet.
For consumers who are unaware of the costs that mandates laced with threats add to healthcare, each one of the training requirements may seem like swell ideas. But for small practices in the real world, similarly expensive HIPAA training requirements have thus far failed to even slow down the increasing frequency of electronic data breaches. As for the threats, once most dentists have been fined $100,000, it might as well be $1.5 million.
Dentists who don’t store and send patients’ electronic PHI aren’t HIPAA-covered entities – avoiding not only risks of data breaches but also the unknown and endless training expenses and severe civil penalties for violations of the law.
Freedman and Browning continue:
“The new law contains severe civil penalties for violations of the law. Penalties can range from $5,000 up to $1.5 million per year for unlawful disclosure of a patient’s PHI. In determining an appropriate penalty, the statute allows a court to consider five factors: the seriousness of the violation; the entity’s compliance history; the risk of financial, reputational, or other harm to the affected patient(s) caused by the violation; the amount necessary to deter future violations; and any efforts taken by the covered entity to correct the violation.”
Are you sure you want to silently walk into this mine field without complaining just a little bit, Doc?
“HB 300 also requires any business in Texas that handles PHI to provide notification to individuals of a breach of their personal information. This is consistent with the requirements of HITECH. Failure to notify individuals may result in a $100 penalty per individual each day the notice is not sent, but not to exceed $250,000. It may also be treated as a class B misdemeanor. The Texas law requires any business, not only covered entities, operating in Texas and handling PHI to provide notice to Texas patients upon discovery of an unlawful disclosure of their PHI.”
One can imagine that from our perspective as dentists, the new state law further increases both the cost and liability of being HIPAA-covered entities even without assurance of improving the security of small practices. Nevertheless, I think we can count on the Texas Attorney General to make October examples of careless providers found to be in violation of HB 300 – just in time for November elections. Let’s face it. It’s going to be a nasty fight in Austin this year, and politicians may try to outdo each other by coming down hard on rich doctors who fumble patients’ identities. It wins votes.
From dental patients’ perspective, other than increasing their dental bills, HB 300 is likely to be just as irrelevant concerning their security as HIPAA.
I watch the internet closely for dental industry news concerning HIPAA. Other than details about breaches from dental offices that are posted regularly on the HHS Wall of Shame, HIPAA in dentistry is no longer mentioned online – not even by HIPAA consultants with advice to sell.
If transparency about security is shunned by leaders in Texas’ dental community, should that reassure consumers or make them feel more vulnerable?
D. Kellus Pruitt DDS
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Pre-emption Doctrine Definition
Darrell – I believe you are referring to the pre-emption doctrine.
http://www.duhaime.org/LegalDictionary/P/PreemptionDoctrine.aspx
The superceding of any lower jurisdiction’s law in the event of a law on topic extant within a higher jurisdiction.
Cimba
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Thanks, Cimba. I didn’t know what it was called, but I believe you are correct.
I also believe the underlying reason providers are so easily vilified and bullied for personal and political gain is because very few doctors risk making a scene. Some may disagree, but docs seem to fear they could look “unprofessional” should they publicly defend the tenets of the Hippocratic Oath against even a harmful government mandate – especially if taxpayers have already paid for it and have been promised 100,000 saved lives and $77 billion a year in healthcare savings… promises already proven to be wrong.
Regardless how much liability feel-good laws intentionally add to the cost of healthcare, American doctors are still not expressing how they really feel about threats from HIPAA/HITECH and HB 300. I find that scary. I hope they don’t sit on their hands for too long.
Passive professionalism has grown too expensive for our patients to afford.
D. Kellus Pruitt DDS
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