The National Provider Identifier: Separating Fact From Fiction What you need to know to establish—and protect—your identity as a health care provider. Bottom Line
Free
Bottom Line  |   February 01, 2015
The National Provider Identifier: Separating Fact From Fiction
Author Notes
  • Lisa Satterfield, MS, CCC-A, is ASHA director of health care regulatory advocacy. lsatterfield@asha.org
    Lisa Satterfield, MS, CCC-A, is ASHA director of health care regulatory advocacy. lsatterfield@asha.org×
Article Information
Practice Management / Professional Issues & Training / Bottom Line
Bottom Line   |   February 01, 2015
The National Provider Identifier: Separating Fact From Fiction
The ASHA Leader, February 2015, Vol. 20, 32-33. doi:10.1044/leader.BML.20022015.32
The ASHA Leader, February 2015, Vol. 20, 32-33. doi:10.1044/leader.BML.20022015.32
All health care providers—including audiologists and speech-language pathologists—need a National Provider Identifier to bill for their services. But as the use of electronic health records expands and more people are getting health insurance coverage, the potential for insurance fraud and identity theft through a provider’s NPI also increase. Clinicians need to understand the facts—and the myths—about obtaining an NPI and protecting their provider records.
The myths
Only audiologists and SLPs who work in health care settings need an NPI.
It is true that the NPI is used in health care facilities to bill health insurers—Medicare, Medicaid, private plans, workers’ compensation. But increasing numbers of local education agencies, schools and universities are also billing insurance plans for services. Generally, every provider who is involved in health care needs an NPI, regardless of where the services are provided. School-based providers should check with their local districts about the need for individual NPIs.
Once I have my NPI, that’s all I need to bill Medicare.
Getting your NPI is only the first step in billing insurance. Many insurers, including Medicare, Medicaid and many private insurers, require you to enroll or complete a credentialing process. Audiologists and SLPs who want to become Medicare providers first need an NPI, then must complete the online Medicare enrollment.
I don’t need an NPI because I work for a physician or I am a clinical fellow.
Everyone who delivers direct patient services should have an individual NPI. Outpatient Medicare claims require the NPI of the providing clinician for each service provided. Medicare requires that claims for hearing and balance services provided by an audiologist include the audiologist’s NPI as the rendering provider. Clinical fellows in states with licensure can obtain an NPI using the speech-language pathology provider taxonomy code (see below) and enroll in Medicare. Students and clinical fellows in states without licensure can obtain a student NPI using the provider taxonomy number 390200000X.
The facts
Getting an NPI is free, easy and available online.
Registering for an NPI is free, easy and online. You need your Social Security number, state license number and tax identification number if you are in your own practice. If you are already enrolled as a provider in Medicare or Medicaid, you will need these numbers, and the appropriate provider taxonomy number (audiologist, 231H00000X; SLP, 235Z00000X).
My NPI can be stolen and used by other providers.
In theory, NPIs are publically available and could be used by someone else. However, the information that is available to the public does not include Social Security numbers or other personal identification needed for insurance enrollment. Identity thieves could not use an NPI to bill insurers unless they had all of the other information and had enrolled in Medicare or the health plan. To help prevent fraud, update all enrollment accounts when your practice location or your employer changes.
If your NPI or medical information has been compromised, you can get assistance from the Centers for Medicare and Medicaid Services, which offers a remediation process and has regional Zone Program Integrity Contractors.
As with other identifying numbers, it is important to monitor the billing notices you receive with your payments. And, of course, share your NPI only with trusted sources.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
February 2015
Volume 20, Issue 2