This was posted a while ago from the NATA and yes it is biased to athletic trainers but I think it is very important as they state in post. As our profession moves into the future I believe this is going to be an extremely integral part.
National
Provider Identifier (NPI)
Importance
to the Athletic Training Profession?
By
Clark E. Simpson, MBA, MED, LAT, ATC
National
Manager, Strategic Business Development
National
Athletic Trainers’ Association
My expectation is that the National Provider Identifier
(NPI) is not news to you. If this assumption is correct, then one out of every
two of you have not grasp the importance of the NPI to the profession of Athletic
Training, or to yourself. Why do I say that? Well, according to NATA’s database,
iMIS, currently only 52% of active ATs have their NPI. (For a breakdown per
state and district, see table at end of article).
So, you
say, “What is the big deal. I am an athletic trainer working in a
secondary school, college/university, administrative or even a healthcare
setting with no intentions of billing for services I am providing. Fifty-two
percent seems pretty good to me, as I am sure that covers the percentage of ATs
working in settings that are interested in billing third parties for services
provided”.
If those or similar thoughts, went through your mind
after the first paragraph, let’s do some review.
What is
the NPI, and why was it created in the first place?
The
National Provider Identifier (NPI) is a unique identification number for use in
standard health care transactions. It is issued to health care professionals
and covered entities that transmit standard HIPAA electronic transactions
(e.g., electronic claims and claim status inquiries).
The
Centers for Medicare and Medicaid Services (CMS) began issuing NPIs to health
care professionals who applied and qualified in May 2005. Health
care professionals and covered entities may apply for NPIs through
the National Plan and Provider Enumeration System (NPPES) established by CMS
for this purpose.
The NPI
fulfills a requirement of the Health Insurance Portability and Accountability
Act of 1996 (HIPAA), and was to be used by health plans and health care
clearinghouses for HIPAA standard electronic transactions beginning May 23,
2007. Health care professionals and covered entities were given an additional
year to become fully compliant with the NPI rule. The contingency period
expired May 23, 2008.
The NPI is intended to:
§ Replace
other identifiers previously used by health care professionals and assigned by
payers (e.g., Unique Physician Identification Number [UPIN], Medicare or
Medicaid numbers);
§ Establish
a national standard and unique identifier for all health care professionals
§ Simplify
health care system administration
§ Encourage
the electronic transmission of health care information
So my question to you, is the above mentioned not what everyone
in the Athletic Training profession is striving for, regardless of setting –
recognition as health care professionals? It would seem that 100% of
active ATs would want an NPI to improve the brand of the AT as a health
care professional regardless of the practice setting.
Secondly,
seeking recognition as health care professionals is a numbers game. When
seeking recognition from CMS, other health care insurers, as well as federal
legislators, the question comes up as to just how large is the organization.
How many health care professionals are we talking about? For comparative
purposes, the following are estimated numbers of health care professional
colleagues:
Medical
Doctors - 954,000
Nurse
Practioners - 106,100
Physician
Assistants - 70,400
Physical
Therapists - 198,600
Occupational
Therapists - 108,800
Compare
to AT:
Athletic
Trainers - 42,000 (30,455 NATA members, remainder are non-members)
Given
that nearly 100% of the health care professional colleagues listed have a NPI,
it is very simple for the federal system to determine their size, and
perceptually, their impact. With athletic trainers, our lobbyists &
governmental affairs activists tell the story of our size, and potential
impact, but there is not an objective means available since only 52% of our
profession has an NPI. This, combined with being significantly smaller than any
of these comparative colleagues, makes our story for recognition weak. Getting
ATs closer to 100% enrolled with NPI will only strengthen our case.
Finally,
recognition of ATs by insurers as health care professionals affects us all, regardless
of practice setting. College/university sports medicine and athletic programs
are looking for additional revenue due to the economy and funding cut-backs.
Secondary school athletic trainers with squeezed budgets are looking to insurer
payment opportunities. Athletic trainers working in professional sports and
performing arts have opportunities to treat and bill for Workers’ Compensation.
Plus there are athletic trainers working in health systems, rehabilitation
clinics and physician offices, all of which are receiving pressure to justify
their value and/or generate revenue. Additionally, recognition can potentially
lead to other types of insurers or
corporations, i.e., Workers’ Compensation, Third Party Administrators and/or
corporations, realizing the true value of AT and eventually pay for prevention,
wellness & education. Having an NPI
is important for this recognition!
So, my
question for you – “What else can you do for your profession, and yourself,
that is free, takes less than 20 minutes, needs to be done only one time
lasting a lifetime and truly has a national impact for your profession? I
cannot think of anything. Can you?”.
More after the jump:
How a health care provider may apply for
an NPI:
§ Apply
through a web-based application process. Access the web address through NATA to
apply for an NPI number at http://www.nata.org/NPI.
§ Also,
the NATA has a step by step process along with the pictures to insure that
obtaining your NPI number is as easy as possible. To see the directions please visit: http://www.nata.org/sites/default/files/Apply-NPI-Number.pdf
Finally,
do you know there are two types of NPI - which NPI is right for you?
There are two types of NPIs: Type 1, for individual health
care providers and Type 2 for incorporated businesses, such as group practices
and clinics.
Type 1 is for the provider. This is the only type of NPI you
will need if you receive payments in your name or under your social security
number as a solo practitioner. For practices with multiple providers, obtain a
Type 1 NPI for each provider.
Type 2 is for group practices, incorporated
medical/rehabilitation practices or other business entities paid under their
business or corporate name, or under their employer identification number
(EIN).
On claims, the Type 2 NPI identifies the payee, and may be
submitted in conjunction with a Type 1 NPI to identify the medical provider who
provided the treatment.
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