NPI Number and How to Get it

(Photo : NPI Number and How to Get it)

Whether you're just starting your physical therapy career or are an experienced veteran, getting your NPI number should be your top priority.

An NPI is a 10-digit numeric identifier that must be used on claim forms submitted to payers by individual and organization health care providers who fit into a wide-ranging definition of a "covered entity" under the Health Insurance Portability and Accountability Act (HIPAA). An NPI also is needed for all providers enlisted in Medicare. The NPI substitutes any legacy or billing numbers for all health insurance programs, both public and private. There are plenty of platforms providing NPI lookup services. You can visit them for more details, information, and your eligibility for NPI.

It does not contain information about you, such as the State where you work, your provider type, or your specialization. Your NPI will not alternate, even if your other data details change. In HIPAA standard transactions, the NPI must be used instead of other provider identifiers, including Provider Transaction Access Number (PTAN), Online Survey Certification & Reporting (OSCAR), and National Supplier Clearinghouse (NSC).

When did NPI numbers begin?

It started in In July 1993 when the Centers for Medicare & Medicaid Services (CMS) worked on a strategy to devise a healthcare provider identification system to fulfill the requirements of the Medicare and Medicaid programs and the needs of a national identification system for all health care providers. The NPI Final Rule, published on January 23, 2004, declared the National Provider Identifier (NPI) as this standard.

Benefits of an NPI

The benefits of an NPI are as follows:

• Easy electronic transmission of HIPAA standard transactions

• Standard distinct health identifiers for health care providers, health care plans, and businesses

• Streamlined coordination of benefit transactions

An NPI also contains other benefits, such as easing electronic transmission of HIPAA standard transactions and effectively coordinating benefit transactions. However, it's important to note that receiving an NPI will not guarantee that you're Medicare credentialed or replace your current insurance enrollment. 

What an NPI doesn't do

Having an NPI will not:

• Modify or substitute your current Medicare enrollment or

• certification process

• Enroll you in a health program

• Ensure you are licensed or authorized

• Guarantee payment by a health plan

• Ask you to conduct  HIPAA transactions

Who may get an NPI?

All health care professionals, including physicians, suppliers, hospitals, and others, may get an NPI. Health care providers are individuals who provide health care as described in 45 Code of Federal Regulations (CFR) 160.103.

Who must obtain an NPI

All health care providers who are HIPAA-covered entities, whether individuals or businesses, must get it. A HIPAA-covered entity is a:

• Health care provider that carries certain transactions in electronic mode

• A Health plan (including commercial programs, Medicare, and Medicaid)

Under HIPAA, you are a covered health care provider if you electronically dispatch health data in connection with a HIPAA standard transaction, even if you use a business assistant to do so. 

Examples of individual HIPAA-covered entity health care providers are:

• Chiropractors

• Physical Therapists

• Nurses

• Pharmacists

• Dentists

• Physicians

Meanwhile, examples of organization HIPAA-covered entity health care providers are:

• Ambulance Companies

• Healthcare Clinics

• Nursing care Homes

• Suppliers of Durable Medical  Equipment (DME)

• Group Works

• Health Maintenance Organizations (HMOs)

• Home Health Agencies (HHAs)

• Hospitals

• Labs

Who may not obtain an NPI?

Any entity that does not fulfill the criteria of a health care provider as defined in 45 CFR 160.103 may not apply for an NPI. These structures include billing services, value-added networks, health plans, health care clearinghouses, non-emergency transportation co-operations, and others.

Why does a holistic practice need an NPI?

A holistic practice will have to get an NPI if it is being practiced by a HIPAA-covered health care provider or is billing insurance for your services. If it applies for enrollment, it will be essential for you to get an NPI. Any enrollment application without an NPI will not be accepted. 

How is an NPI number used?

An NPI number is a distinct ID for each health care provider or entity and is needed to be used by all healthcare plans for every administrative and financial transaction. Different health plans designated their own ID numbers to each health care professional. It ultimately resulted in every provider using a different ID depending on which health plan they were submitting claim forms to. Now, the universal NPI number has made billing and tracking more accessible, more effective, and streamlined. 

The NPI number is applied to any electronic transaction identifier in HIPAA. Healthcare professionals may also use it to identify themselves or other providers in healthcare transactions or related correspondence; by doctors on prescriptions; by health plans in their reporting and transactions; to connect benefits with other health plans; to identify health care providers in electronic patient medical records (EMRs); by the Department of Health and Human Services to track providers in fraud and violation cases, and other purposes.

How do you get an NPI number?

The best and easiest way for health care providers and organizations to get an NPI number is to apply through the National Plan and Provider Enumeration System (NPPES). Only 20 minutes may be required to complete the application. You may get the NPI in around ten days. Individual providers must first create a username and password through the Identity & Access Management System (I&A). They can log in to NPPES using those credentials and fill out the application.

Providers can also apply for an NPI number through a hard copy, i.e., paper form. Organizations can apply to get NPI for their employees on their behalf. Complete instructions and more details can be checked on the CMS website here.

NPI numbers are important for accurate medical billing and boosting the revenue cycle system.  As an NPI is required by HIPAA regulations to track healthcare services and remunerations, any claims submitted without an NPI will be rejected altogether by any health plan.