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Clarifying Some NPI Number Mis-Understandings

The NPI Number: What is is – How it works?

By Carol S. Miller RN, MBA

The National Provider Identifier (NPI) is a HIPAA Administrative Simplification Standard that provides a unique identification for covered health care providers, all health plans and health care clearinghouses.  The NPI must be used in administrative and financial transactions adopted under HIPAA and with one identifying number will simplify security and allow greater protection or encryption of the provider number.  The NPI can be used to identify the health care provider on prescriptions, COB between health care plans, inpatient medical record systems, program integrity files, and other areas.

Dependent on his/her medical practice, the provider can obtain an individual or group NPI; however, there are situations where an individual NPI number is required such as with the submission of pharmacy and lab claims.  The NPI remains with the provider regardless of job or location change.  NPI will eventually be the standard identifier for all e-prescribing under Medicare Part D.

A Ten Digit Number

The NPI is a ten digit, intelligence-free numeric identifier with a check digit in the last position to help detect keying errors.  If there is a security breach, the number in itself cannot identify the protected health organization.  The use of one identifier with a check digit simplifies encryption of this number when transmitted electronically and thereby enhances security.

On HIPPA

HIPAA also requires that employers have standard national numbers that identify them on standard transactions.  The Employer Identification Number (EIN), issued by the Internal Revenue Service (IRS) was selected as the identifier for employers.  This number is used as a Federal tax identification number for the means of identifying any business entity and for the purpose of reporting employment taxes.  The EIN number should be protected as a social security number is.

ITL and NIST

Both the Information Technology Laboratory (ITL) and the National Institute of Standards and Technology (NIST) are involved in the development of technical, physical, administrative, and management standards and guidelines for cost-effective security and privacy of sensitive unclassified information in federal computer systems.  These standards and guidelines can be applied to the management of medical IT.

Assessment

Additional reference material for NPI can be found at: www.cms.gov/nationalprovidentstand.

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3 Responses

  1. Thanks, Carol Miller

    So how does the NPI number improve patient care?

    D. Kellus Pruitt DDS

    Like

  2. NPI games in dentalcare

    Since I don’t share my patients’ dental claims and identities using the internet, I have never been a HIPAA covered entity, and am therefore not forced by mandate to “volunteer” for a National Provider Identifier (NPI). Nevertheless, about three years ago, not having an NPI – an arbitrary ten-digit number which does nothing to improve the quality of patient care – forced several of my long-term patients to leave my practice before BCBSTX’s half-baked edict that “paper claims without NPI numbers will not be processed” was abandoned.

    In 2008, around the time my disagreement with BCBSTX had been resolved to the satisfaction of my BCBSTX patients who hadn’t left my practice, I heard a Delta Dental official tell an audience gathered at ADA Headquarters that after data-mining several years of dental claims, they discovered that “changing dentists causes fillings.” I call that redemption.

    Even though BCBSTX and other discount dentistry brokers learned a hard internet lesson about how far some dentists will go protect the patients they love from unnecessary treatment in another office over a meaningless number, not every insurance executive was paying attention. In a pre-recorded message on “Aetna’s Dentist Line” which is used by thousands of dental offices nationwide to determine Aetna’s deductibles, coverage and maximum benefits before initiating treatment (informed consent), my office was recently informed, “We do not have your NPI on file with Aetna. In the coming months you will not be able to access this system without your NPI.”

    I think totally unforeseen problems arose in BCBSTX Headquarters when someone on staff suddenly realized how awkward it would be to lawfully inform clients, “As Americans, you are free to choose your favorite properly licensed dentists. But if they don’t have NPI numbers, BCBSTX will not process your dental claims even if you pay the bill out of pocket.”

    On the other hand, Aetna’s even sillier edict will be abandoned when their surprised counterpart realizes that state attorneys general could become equally upset with them if Aetna clients aren’t informed, “As Americans, you are free to choose your favorite properly licensed dentists. But if they don’t have NPI numbers, Aetna will not share the details of your coverage, and your dentist will have to guess what your part will be. Don’t blame us. We didn’t make the HIPAA Rule.”

    D. Kellus Pruitt DDS

    Like

  3. Igonorance of NPI
    [ADA members’ ignorance of the NPI is no accident]

    A few days ago, I posted the question, “Why should dentists volunteer for permanent NPI numbers?” on the Dental Geeks Linkedin group discussion.

    The responses revealed how little most dentists know about the 10 digit identifier they unquestioningly volunteered for on the advice of ADA officials whom dentists used to be able to trust.

    http://www.linkedin.com/groupItem?view=&gid=70084&type=member&item=117231619&qid=5aebfb73-a698-462c-9425-c626541408eb&trk=group_most_popular-0-b-ttl&goback=%2Egde_70084_member_109649970%2Egmp_70084

    My response:

    The ignorance that surrounds the NPI is no accident, folks.

    Am I truly the only dentist in the nation who asks common sense questions of dental care stakeholders who would trick dentists into volunteering for permanent identification numbers? This is the land of the free. Being American means not having to tolerate tyranny – mandate or not.

    Thanks for your comment William. Regardless of your premature opinion that Michelle and Blake “summarized the issue nicely,” anyone following this much needed discussion about HIPAA can easily tell that neither one made a single convincing argument for adopting the NPI.

    Blake says the NPI protects dentists’ identities. That’s simply wrong. Physicians’ NPIs are already being used by Identity thieves to defraud Medicare. It’s a rapidly growing problem and the investigations always result in a tedious, nerve-racking audit – even if the provider is innocent. So if the NPI does nothing to benefit the dentist or dental patient, why would a smart businessperson volunteer for such unnecessary liability unless he or she was tricked? Do you see my point?

    In Michelle’s well-considered answer, she accurately explains how the arbitrary 10 digit number saves office expense for stakeholders in the dental industry, but not dentists. She also confirms that the NPI does NOTHING to improve patient care. You may feel differently, but I argue that it is not dentists’ Hippocratic or patriotic obligation to help Delta Dental save on overhead so that they can be more competitive.

    And did you know that if there is a screw up with any part of the NPI on the NPPES crosswalk – whether it’s the dentist’s fault or insurer’s – it ALWAYS means a delay in payment? Are delayed payments something you really want to risk for no tangible benefit, Doc? Even without the high inflation rates that many anticipate, how do you feel about administrative complications “that cannot be helped,” long after your satisfied patient has left the office? Insurers always have a disincentive to simplify payment to dentists, and the NPI just gives them one more tool for unaccountability.

    Does anyone dare wonder what else dentists have not been told about the NPI? How about cost control? Imagine a nationwide, internet report card for dentists – determined not by satisfied patients, but by insurers and/or CMS through data mining of dental claims.

    If the ADA and Delta Dental officials had been honest with dentists, they would have long ago warned that by accepting NPI numbers, dentists give any number of ambitious entities permission to determine their reputations and future earnings potential according to dental claims data mining. The ADA has already hinted that patients’ preferences are too unscientific for quality control measurements. That should frighten patients even more than dentists.

    If the national NPI-driven cost control plan is news to you Doc, you should complain to whoever betrayed your trust by giving you bad politically-correct advice without telling you the whole story. And did I mention that the number is permanent? Remind your friend that if you back out now, you’ll forever have a permanent stain on your permanent report card.

    We’ve been had, Doc.

    D. Kellus Pruitt DDS

    Like

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