|
By Phyllis Hanlon
The Health Insurance Portability and Accountability Act of 1996
(HIPAA) has issued a number of mandates designed for secure delivery
and administration of health care. On May 23, 2005, another program
under HIPAA Administration Simplification will be adopted. The
National Provider Identifier (NPI) will become the standard means
of identifying all health care providers, overriding all other legacy
numbers and identifiers now used with certain insurance carriers
and health programs.
The NPI is intended to improve federal health programs, including
Medicare and Medicaid as well as private health plans, by streamlining
the health care system's administration and facilitating the electronic
transfer of medical information. The intent is to reduce the cost
of exchanging health care and to decrease the incidence of fraud
and abuse.
The NPI is a 10 digit numeric identifier that will not contain
embedded information regarding the provider, (e.g., the type of
healthcare provider or the state in which the provider is located).
All health care providers who submit claims or conduct business
under the HIPAA regulations are required to apply for a NPI. Once
the NPI program is implemented, all other identifiers will no longer
be necessary with the exception of the Taxpayer Identification Number,
which will still be needed for tax purposes.
Two different types of NPIs will be issued. Individual healthcare
providers will be given an NPI with an Entity Code 1, signifying
their status as a single provider. An NPI with an Entity Code 2
will be attributed to organizations or "subparts" such as hospitals,
home health agencies, clinics, nursing homes, residential treatment
centers, group practices and other large establishments. These subparts
may require NPIs if they conduct transactions on their own behalf
or to meet regulations regarding reimbursement.
Providers may begin the application process as of May 23, 2005,
the effective date of the rule. To apply, providers must complete
a paper or electronic application form. The Centers for Medicare
and Medicaid (CMS) have contracted to construct a National Provider
System (NPS) that will manage the application process, update information
and issue the NPIs.
The NPS will also publish reports upon request from the healthcare
industry and other interested parties. An enumerator, a single entity
within the NPS, will act as point person, offering assistance to
providers throughout the application process. Providers must update
information within 30 days of any changes, once the NPI has been
assigned. Individual providers must comply with the NPI rule by
May 23, 2007; small health plans have until May 23, 2008 to meet
the rule's terms.
According to the Centers for Medicare and Medicaid (CMS), based
on the current rate of provider growth and the format of the NPI,
approximately 20 billion unique identifiers should be available,
that would cover the health care industry for the next 200 years.
As the effective dates draw closer, CMS will provide more information
regarding NPIs and how to apply. For more information on the NPI
final rule, visit the CMS Web site at www.cms.hhs.gov/hipaa/ hipaa2.
|
