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Psychologists
must acquire National
Provider Identifier
(December
2006 Issue)
By Pamela Berard
All health care professionals - including psychologists - are required
under federal law to acquire a National Provider Identifier (NPI)
by May 23, 2007.
The Health Insurance Portability and Accountability Act (HIPAA)
has mandated NPIs to create a standard of unique identifiers for
health care providers and health plans. The 10-digit number is random
and does not reveal any specific information about the provider,
such as geographic location.
The NPI is intended to simplify administrative paperwork by requiring
all third party payers to use the same identifying number for individual
providers. Under the current system, Medicare, Medicaid, and other
third party payers each issue their own unique number that practitioners
have to use when submitting claims. The NPI will replace those numbers
so that practitioners use the same identification number when submitting
claims to any third party payer.
The Centers for Medicare & Medicaid Services (CMS) has developed
the system to assign the identifiers.
Health care professionals must complete the NPI enrollment process.
The NPI application is available online at https://nppes.cms.hhs.gov
or by paper application process via www.cms.hhs.gov/ cmsforms. It
is estimated the form takes about 20 minutes to complete. Psychologists
must provide the following information: name, social security or
ITIN number, date of birth, state and country of birth, gender,
mailing address, practice location address and phone number, taxonomy
(provider type), state license information, contact person name,
contact person phone number and e-mail.
The taxonomy code describes the health-care practice, which the
CMS indicates will help differentiate between health professionals
who have the same name. The codes are outlined at the Web site:
www.wpc-edi.com/taxonomy. "Psychologist" and "Neuropsychologist"
are listed under "Behavorial Health and Social Service Providers."
There are also 19 specialty codes listed under "psychologist," but
concerns have been expressed that choosing a sub-category might
limit or constrain the provider in his or her practice.
According to the American Psychological Association Practice Organization,
there is no published guidance from CMS regarding how to choose
a code.
The APA Practice Organization indicated it is concerned that third-party
payers may limit or deny reimbursement based on a psychologist's
choice of taxonomy codes. One example from the Practice Organization
is that an insurer might deny payment for services that a psychologist
provides to children if that practitioner has not chosen the specialty
code for children from the taxonomy code list. The APA Practice
Organization evaluated the issue of choosing taxonomy codes and
has identified strategies psychologists may take: choose all the
taxonomy codes that represent any area of your practice (you may
opt to pick only the specialty codes and not a general taxonomy
code); list only the general "psychologist" or "neuropsychologist"
code; choose the code or codes that most accurately reflect your
practice in its entirety (the services you spend the majority of
your time providing).
Psychologists who focus in specific practice areas may want to
choose a specialty code or codes in addition to a general code.
For example, the Practice Organization advises, a neuropsychologist
who focuses on providing services to geriatric clients might choose
the general "neuropsychologist" code and the specialty code, "adult
development and aging." The APA Practice Organization indicated
it generally advises this approach.
The Practice Organization indicated that its guidance may change
when it becomes clearer how insurers will handle the codes.
Practitioners may add or delete taxonomy codes at any time, but
will keep the same NPI even if they relocate, change employers or
change health professions.
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