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Are you ready for the NPI? Time to learn about a new reimbursement essential.

Has your nursing home signed up for its National Provider Identifier (NPI) yet? Has it implemented a plan to put the NPI to work? Get a jump on both tasks now so that your facility will be in compliance by the May 23, 2007, deadline.

Some nursing home professionals are asking, "What's the big deal?"

It's simple. "If your organization isn't using an NPI after May 23, 2007, it will not get paid [by CMS or any other payer or health plan]," says Stephen C. Witter, vice president at Folio Associates in Hyannis, MA.

How to register for your NPI

Alert everyone in your institution who performs billing functions for the facility about the NPI. Apply for your facility's NPI online or download a paper form to fill out, says Susan A. Miller, JD, independent consultant and chief operations officer at in Massachusetts. Register online at or request a paper application by calling 800/465-3203.

After applying, your facility will receive an NPI number and an official correspondence and the NPI number. Save both, Witter says.

This single provider identifier will replace the different identifiers your facility currently uses for each health plan with which you do business, CMS reported in May 2005.

The NPI effort comes from a HIPAA mandate and must be used to identify healthcare providers in standard electronic transactions, and in most cases paper as well, such as the following:

* Claims

* Eligibility inquiries and responses

* Claim status inquiries and responses

* Referrals

* Remittance advices

Not only will organizations such as nursing homes, rehab centers, hospitals, pharmacies, and group practices need NPIs, so will individual healthcare providers such as physicians, dentists, and pharmacists. Providers also include organizations such as nursing homes, hospitals, pharmacies, and group practices, according to CMS.

How do subpart NPIs work?

The SHARPWorkGroup and CMS presented a panel discussion of NPI issues in July. Miller is a leader of the SHARPWorkGroup, a regional standards implementation group for Southern states, and said that many questions came up about subparts.

Subpart NPIs fall under the categories Type 1 or Type 2.

Type 1 NPIs are intended for individual healthcare providers such as physicians. Type 2 NPIs are given to organizations.

HIPAA-covered entities must obtain at least one NPI, and can obtain additional NPIs for their subparts. For example, if a skilled nursing facility (SNF) also includes an assisted living facility and a dialysis unit, the SNF has a choice to obtain one NPI number for the facility or multiple sets of NPIs for individual units, Miller says.

"It's no longer the payer's choice; it's the facility's," Witter adds.

To decide which option works best for your facility, Miller suggests asking what your organization looks like legally. Witter echoes this in saying that the NPI strategy depends on the facility's governance, corporate strategy, and business mindset.

For example, are different entities separately incorporated or licensed? Do you now run different parts of your organization with different senior management?

Proper use of the NPI in the nursing home

To properly use the NPI process in a nursing home, the facility will need to access NPIs for the following referring providers as well, Witter says:

* Physicians

* Home health agencies

* Outside clinical social workers

* Outside physical therapists

How to obtain these NPIs may prove challenging, however. No information currently exists on how to get this information, but Witter says you may access it through the following outlets:

* The CMS Web site

* Third-party databases or services

* Your state agency

* The facility itself gathers information

Keep in mind that your pharmacy claims won't be processed without NPIs of prescribing physicians, Witter adds.

How to build your NPI team

Although your SNF's billing staff needs to be on top of the list to know about the new NPI process, don't stop there. Build an NPI team across your organization.

Include the following departments in forming your facility's NPI team, say Miller and Witter:

* Corporate office or board of directors: You will need legal advice on using the NPI as you draft new policies and procedures and possibly update current ones, especially those related to getting authorization to enumerate physicians and getting the providers permission to disseminate NPIs.

The corporate office or board is also essential in reviewing governance, legal requirements, and health licensing to determine how to divide the organization regarding NPIs.

* Administration: Beyond the corporate office or board, administration needs to be involved in the NPI process to discuss governance, strategic plans, and the effect payer contracts and affiliation agreements will have on the organization.

* Billing staff: Billers need to add their depth and understanding of billing and payments, chart the changes, and oversee testing and implementation of using the NPI. This is essential because the bottom line of the NPI is to lessen the risk of cash flow disruption.

* Admissions: These staff collect the first level of data that directs claims and payment. Admissions staff may now need to collect additional data. Include them in workflow decisions related to obtaining NPIs proactively, and from new and referring physicians.

* Pharmacy: Pharmacies use provider identifiers differently than other areas and should to present their needs and barriers for your nursing home's consideration. Plus, pharmacies will be moving from National Council for Prescription Drug Programs provider numbers to NPIs.

* Information technology: Staff will bring their knowledge and understanding of all the various technical tools and vendors to the team. They will help control and reconcile the interfaces (the work and data flows) between the various ancillary systems.

How to find more about NPIs

If you're hungry for more National Provider Identifier (NPI) information, the Workgroup for Electronic Data Interchange (WEDI) provides several reports that can guide your facility through the implementation process.

"WEDI happens to be one of the key advisors to the Department of Health and Human Services, and it's done quite a bit of work on the NPIs," said Chris Apgar, CISSP, president of Apgar & Associates, LLC, in Portland, OR. He spoke on this topic during the HCPro audio-conference, "National Provider Identifier: Know how changes will affect your business."

Apgar suggested going to the WEDI Web site's National Provider Identifier Outreach Initiative ( Click on the "SNIP Work Products" link to access the following free reports:

* National Provider Identifier Overview and Educational Reference Guide, Final Version

* National Provider Identifier Registration Process, Final Version

* Impact of the National Provider Identifier on Health Plans and Payers White Paper

* Dual Use of NPI & Legacy Identifiers White Paper

* Impact of the NPI on Healthcare Providers, Final Version

* Impact of the NPI on Clearinghouses, PBMs, and Vendors, Final Version

* NPI Subpart Designation for Organizations Nursing homes can also look to the following sites for more information:

* Overview information:

* NPI fact sheet: downloads/npi_fs_geninfo_010906.pdf

--Michael Iarrobino

Janet Spiegel is a Managing Editor to HCPro. Additional reporting from HCPro's Michael Iarrobino was used in this article.
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Author:Spiegel, Janet
Publication:Contemporary Long Term Care
Date:Oct 1, 2006
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