BARDA (Biomedical Advanced Research and Development Authority) within the Office of the Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services, uses a comprehensive integrated portfolio approach to the advanced research and development, stockpile acquisition, innovation, and manufacturing infrastructure building of the necessary vaccines, drugs, therapeutics, diagnostic tools, and non-pharmaceutical products for public health medical emergencies including chemical, biological, radiological, and nuclear threats, and pandemic influenza, and emerging infectious diseases. (Courtesy of hhs.gov)
Archive for September, 2010
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What is a NPI again?
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.
As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes.
When should you get a new NPI?
The National Provider Identifier (NPI) is meant to be a lasting identifier, and is expected to remain unchanged even if a health care provider changes his or her name, address, provider taxonomy, or other information that was furnished as part of the original NPI application process. There are some situations, however, in which an NPI may change such as when health care provider organizations determine they may need a new NPI due to, for example, certain changes of ownership, the conditions of a purchase, or a new owner’s subpart strategies. There also may be situations where a new NPI is necessary because the current NPI was used for fraudulent purposes.
A health care provider (or the trustee/legal representative of a health care provider) should deactivate its NPI in certain situations, such as retirement or death of an individual, disbandment of an organization, or fraudulent use of the NPI. To deactivate an NPI, a health care provider (or the trustee/legal representative of a health care provider) must complete a CMS-10114 and mail it to the NPI Enumerator.
Does the NPI replace the tax ID number?
The billing provider’s tax ID number and NPI are always required on claims. Any other providers identified on the claim, such as rendering provider or service facility, must be identified with their NPI only. Their tax ID number should not be included.
For eligibility, claim status inquiry, referral and precertification, only the NPI (no tax ID number) is used.
How does a rendering physician report their National Provider Identifier (NPI) on a claim that includes Physician Quality Reporting Initiative (PQRI) or Electronic Prescribing Incentive Program (eRx) quality-data codes (QDCs)? What if he/she is part of a group and the group NPI is used on the claim?
Your individual National Provider Identifier (NPI) must be included on the claim line items for the quality-data codes (QDCs) you submit as well as the line items for the services to which the QDC is applicable. The PQRI/eRx QDC must be included on the same claim that is submitted for payment at the time the claim is initially submitted in order to be included in PQRI analysis.
If a group NPI is used at the claim level, the individual rendering physician’s NPI must be placed on each line item, including all allowed-charge and quality-data line items. See the PQRI Implementation Guide for a sample CMS-1500 claim. This is available as a download from the Measures/Codes section of the CMS PQRI website. For eRx, see the Claims-Based Reporting Principles for eRx, available on the CMS eRx website.
If a health care provider with a National Provider Identifier (NPI) moves to a new location, must the health care provider notify the National Plan and Provider Enumeration System (NPPES) of its new address?
Yes. A covered health care provider must notify the NPPES of the address change within 30 days of the effective date of the change. We encourage health care providers who have been assigned NPIs, but who are not covered entities, to do the same. A health care provider may submit the change to NPPES via the web or by paper. If paper is preferred, the health care provider may download the NPI Application/Update Form (CMS-10114) from the Centers for Medicare & Medicaid Services’ forms page or may call the NPI Enumerator (1-800-465-3203) and request a form.
What happens when you join a group?
In Section 4B of the CMS-855I, the NPI of the Group should be entered if it has been issued to the Group. If you are joining a group, the group is responsible for providing you with their current Provider Identification Number (PIN) and the NPI, if they have been issued.
If you are a solo physician with an incorporated practice, how many NPIs should you have?
An individual is eligible for only one NPI. In the above example, there are two health care providers: the physician and the corporation. The physician would obtain an NPI (Entity Type Code 1, Individual). The corporation would obtain an NPI (Entity Type Code 2, Organization). Generally, the corporation’s NPI would represent the Billing and Pay-to Providers and the physician’s NPI would represent the Rendering, Referring/Ordering, Attending, Operating and/or Other Providers. These physicians should ensure that their enrollment records with the health plans to whom they will be sending claims are up to date, that those health plans are aware of the assigned NPIs, and that the NPIs are used in a way that is compatible with their enrollment.
I do not submit healthcare claims to Medicare; do I need a National Provider Identifier (NPI)?
Where can you look up NPIs?
A SSO server stores passwords in a safe database and makes it available to the user transparently during the login process. The end result is that the user has to sign in just once.
Walking the Path is the official blog of the Path of the Blue Eye Project. This initiative is designed to encourage collaboration and knowledge sharing among health marketing communications pros from around the world.
SRDP is the requirement for physicians to disclose ownership in ancillary entities and to provide patients with alternatives.
Recorded Future is a temporal analytics engine that evaluates topics of interest. The topic’s exposure and conversation in the media generate a timeline, activity line and sentiment temperature index that one might predict future activity from.
The Recorded Future site suggests some potential uses of their services:
- Financial Analyisis & Trading
- Competitive Intelligence Research
- Brand monitoring
For instance, if you are a practice thinking of adding botox administration to your services and wondered if the market for botox was cooling, you could pose your question to Recorded Future and they could give you the historical data on where botox has been and possibly, where it’s going. More adoption? Adoption by younger people? Greater penetration on the East Coast than the West Coast, etc.
My current practice is getting ready to go live on Electronic Medical Records (EMR) in just two short months, but it’s taken us over a year to get here. When I first started this job, we were supposed to go live with EMR in two months. After I’d had a chance to speak with everyone, I just knew the timing wasn’t right for the EMR. We would need to be able to run, and at that moment we were just starting to crawl.
What were the signs we weren’t ready?
- communication problems with the vendor, who provided the existing practice management system and the new EMR
- issues with the practice management system which had been mis-identified as being support-related
- basic decisions had not been made: one shared medical record for all clinics or individual records for each clinic?
- no single point person who was keeping everything together
- lots of frustrated and worried faces – did we know what we were doing?
A sigh of relief…
Although we knew we wanted the EMR and we had already made the investment, we also knew it might be a train wreck if we didn’t get some other questions answered first. When I announced we were going to delay the go-live until we had some other issues resolved, there was a sigh of relief from all involved.
What did we do to get ready for EMR?
- We attacked the support problems by rerouting all support issues through one person – me. I kept a detailed log of all support issues and the resolution of each. I found the vendor to be surprisingly helpful and issues relatively easy to resolve. As I asked questions and we fixed issues, we found that much of our problem was training-related.
- We held a major training event where all non-clinical staff were retrained to use the practice management system and everyone was given new cheat sheets for the correct way to use the system.
- We realized that staff were worried about the impact of the EMR because the providers were overwhelmed with the current workload. They didn’t know how we would get through the pre-live work, the huge challenge that is the go-live and first few months of adjustment. After some intense evaluation, we changed our scheduling strategy and moved established visits from 15 minutes to 20 minutes, adding four work-in appointments and setting rules for adding more than four work-ins.
- We took the vitals out of the halls and into the exam rooms, making the office quieter and the patient interactions private.
- We also got control of most of our paper processes that weren’t working. We color-coded messages, re-educated patients about new ways of communicating with us and we managed to bring our fax and phone call volumes down to a manageable number.
- We assigned nurses to the providers and asked the provider-nurse duos to put their arms around their patient panels as a team. The patients love it. We moved a float nurse to a triage nurse position to start taking all requests for same day sick visits and scheduling them appropriately.
- We are soon to add an answering service (I prefer the term “virtual receptionist”) to our phones. The virtual receptionists (1000 miles away!) will take calls for the nurses and providers, typing them directly into our EMR.
- We also started a front-end collection system, bringing our accounts receivable under control by adding automated eligibility, a new financial policy, collecting co-pays at check-in, calling patients with old balances before they arrived for their visit, and instituting a discount for non-insured patients.
How will you know when your practice is ready for EMR?
- You are not overwhelmed on a day-to-day basis. If your practice isn’t running well without an EMR, it is not going to run better with an EMR. If you are having operational issues, consider having a consultant help you set up new processes to handle the hurdles you’re facing now. The EMR does not fix operational issues, with the possible exception of lost paper charts.
- Your staffing is stable. There will always be some employees coming and going, but if you are experiencing one of those cyclical shifts when you have several new staff at once (especially nurses), you might want to give them a little more time to get a handle on their jobs before introducing EMR.
- You have your practice management act together – your PM works well and is up-to-date.
- Your finances are in order. If it takes several months of lower productivity, followed by less collections, you can weather the storm because you are on top of the dollars.