History of the NPI Number

One of the terms we’ve all come to hear at some point in our lives is HIPAA, though not everyone knows what it stands for. HIPAA is the Health Insurance Portability and Accountability Act, and it may not be as old as you think. HIPAA was passed in 1996 as a federal law that set standards for protecting private health information. This meant that patients would have to give their consent for any health-related information to be given.

As such, there needed to be a system in place to make sure that healthcare providers could be identified under HIPAA laws. This led to the creation of the National Provider Identifier, or NPI for short. An NPI is a 10-digit number that is used for billing purposes. It helps to prevent the specifics of a patient’s visit to a healthcare provider from being identified, keeping it strictly about the money.

NPI numbers spent years in the making after HIPAA was approved in 1996. On May 23, 2008, the implementation of NPIs went into full effect in what was known as the “final rule.” The rule had been put into place more than four years prior, with most healthcare providers needing to be compliant by May 23, 2007. Penalties weren’t put into the place during that first year, but everybody had to be on board by 2008.

Providers have to apply for an NPI number before they can practice. The number is then used by private insurance companies, as well as Medicare and Medicaid. Prior to the implementation of the NPI, the American healthcare system used the Unique Physician Identification Number, or UPIN. The UPIN was used primarily for Medicare and included only six numbers. This plan took effect in 1985 as part of the COBRA (Consolidated Omnibus Budget Reconciliation Act) plan but was discontinued when NPIs went into full effect.

So what types of healthcare providers are required to have an NPI number? Here’s a comprehensive list of who has them:

  • Athletic Trainers
  • Chiropractors
  • Clinical Social Workers
  • Dentists
  • Denturists
  • Midwives
  • Nurse Anesthetists
  • Nurse Practitioners
  • Optometrists
  • Pharmacists
  • Pharmacy Technicians
  • Physicians
  • Physician Assistants
  • Physical Therapists
  • Professional Counselors
  • Prosthetists
  • Occupational Therapists
  • Orthotists

Note: Not everyone that works in the healthcare industry will need to obtain an NPI number. This includes orderlies, janitorial staff, etc.

Other Uses For NPI Numbers

When it comes to employers, NPI numbers are only used for transactional purposes. That doesn’t mean that NPI numbers can’t be used in other ways, though. Healthcare providers use it for identification purposes every day, including communicating with other providers, including in prescriptions. Healthcare providers will need to know the full benefits and coverage of each individual’s plan, so it’s important to have an open line of communication that’s avoiding fraud through the use of NPI numbers.

NPIs are used in investigations into fraud cases by the Department of Health and Human Services. There have been instances of people saying that they have received medical attention in civil cases, but provided misinformation including false NPI numbers. These numbers are easily validated, making fraud cases less numerous over the years.

Finding NPI Numbers

There is an open database of NPI numbers that have been registered with the Department of Health and Human Services. The general public is able to access this information online, using an NPI number that was provided or entering the healthcare provider’s information. The database is updated every day as applications are approved, making it easier for people to make sure that their doctors are on the level.

Remember, with the HIPAA act going into effect, you have control over your health records. In the end, you get to dictate who’s able to access this information and how it’s used. The NPI numbers are a result for that, making things safer for all parties.

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