When becoming a healthcare service provider, there are a number of steps that should be taken to ensure proper compliance while considering a variety of standards, such as insurance credentialing and HIPAA. However, taking all these steps is crucial to ensure as HIPAA compliance is a critical standard that can give you the smoothest reimbursement process possible. Among these crucial steps, obtaining an NPI number tops the list.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is explained as a federal law that is required for the creation of national standards in order to protect sensitive patient health information from getting it disclosed without consent or knowledge of the patient. Moreover, the US Department of Health and Human Services (HHS) issued a HIPAA Privacy Rule which needs to be implemented for the requirements of HIPAA. In addition, the HIPAA Security Rule also protects a subset of the information which is covered by the Privacy Rule.
Often the question arises, who needs an NPI number and how to get an NPI number? To obtain a National Provider Identifier (NPI), an individual must have the credentials of academic medical procedures and have to pass a process as a trainer. Although, not having formal training or any medical compliance course knowledge does not qualify you or any healthcare individual for an NPI number. Professionals encounter significant circumstances for not having NPI numbers while performing insurance billing purposes.
A brief introduction to NPI Number
An NPI number is a 10-digit numeric number that is given to all healthcare providers as an Administrative Simplification Standard under HIPAA. It contains no personal information about the provider and therefore does not contain any personal information. Moreover, all covered providers should use their NPIs during financial and administrative transactions in accordance with the HIPAA standards.
The highly trained professional holds certification in medical or the person who is eligible and accredited to perform medical tasks, take care of patient health and assist patients in getting insurance for billing purposes.
Credentialed and better medical trained professionals are more likely to serve better yet demystified inpatient health education. They can assist their patients better and help patients make them aware of better health. These professionals also become better health care providers because there had put their time into versatile but long-term medical training.
A recent publication by HIPPA regarding privacy rules submerged the uncertainty of risk for providing health education. Furthermore, the non-physician health care professionals like nurses, nutritionists, pharmacists, or mental health professionals earn practices in vast quality of qualification for patient health care education and passed by consistent guidelines criteria specified or acknowledged by a physician society, non-physician healthcare experienced society/association, or other right accredited training source.
Worth of Having NPI Number
Most of the nursing staff have stated that completing their accredited from medical institutes and receiving NPI number has helped them assist their patient. They love to work with their clients or any other health consulting agency that provides professional service of health at home for those patients who are not able to come to the hospital; the NPI number offers them the “Big picture of Health®” and guides them on methods to prevent from disease or improve their health more consciously.
What are the two types of NPI providers?
HIPAA in its privacy rule declares that there are two types of NPI providers,
Type-1 NPI: It includes those individuals who needs an NPI number as a sole property, such as physicians, surgeons, and dentists, who solely claim to provide service. This type of provider is only eligible for a single NPI.
Type-2 NPI: These included organizations and may contain critical care facilities, hospitals, health systems, physician groups, assisted living facilities, and healthcare providers who have incorporated.
Questions asked by Health educators or medical care teachers regarding NPI Numbers are mentioned below.
Can NPI Number help new graduates be on a highly professional list?
Those individuals who recently completed the degree course from the National Institute of Whole Health (NIWH) have successfully completed the entire course with motivation and have developed good engagement.
After applying for an NPI number, it helps the medical students to collaborate and contract with free-standing clinics and ease in receiving payments for their services.
Sounds interesting, RIGHT?
This is not enough; the NPI number also allows patients to be reimbursed either fully or partially through their flexible insurance plan or private insurance.
Can a healthcare provider and health educators get a National Insurance Provider (NPI) number?
The good news is, YES! Healthcare educators who have appropriately trained and health care individuals who have credentials are eligible for an application to obtain an NPI number. Furthermore, for liability insurance of health education services, they can apply for that.
Can a health educator’s assistance be billed for and compensated?
Yes, there are two ways for billing and prospect reimbursement. Where appropriate, and with the applicable CPT codes, services of a health educator may have billed for and reimbursable via medical practice, nurse practitioner’s approach, physician’s practice, or other medical professional provider’s office. Similarly, healthcare spending plans and employer flex spending plans may be provided to the patients who directly receive service from a health educator, that has a National Insurance Identification number.
Unique Physician Identification Number (UPIN) does it is replaced by National Provider Identifier (NPI)?
Medicare a healthcare identification provider had established the UPIN for physicians and other medical practitioners to provide the surrogate of the Social Security number for physicians and other medical practitioners. However, UPIN expired in 2007 when CMS introduced NPI numbers as the selected provider identification number and replaced UPIN. The reason for this origination was to standardize the process. Additionally, NPI will remain once an NPI number is created for a provider. It will not change regardless of the change in position or designation or a provider’s location.
Does NPI replace Tax Identification Number (TIN) or Other Identifying Numbers?
Taxpayer identification number (TIN), Drug Enforcement Administration registration, license number, or Social Security number is not being replaced by NPI number. It does substitute prior providers’ identification numbers who declare to provide healthcare information transactions and billing because NPI itself denotes the unique identity provided by government officials.
How to examine an NPI number
There are several ways to perform an NPI verification for an organization or a provider.
NPPES NPI Registry is the NPI official lookup website. Anyone who wants to examine provider identity can freely access the website.
The step for the verification is either to start with a name or with an NPI number. The NPI number includes in the search result, proceeding with the first and last name of the provider; the icon has indicated an NPI type, address is primary practiced, phone, and primary taxonomy.
If you are a provider and need to understand the NPI results and the steps you should consider to verify the NPI number
As discussed above, the NPI is an impressive 10-digit number provided by HIPAA.
- Enumeration Date
When NPI is assigned to the provider, that date is named Enumeration Date.
- NPI Type
As discussed above, there are two types of NPI numbers, Type-1 for individuals and Type-2 for organizations.
The status tells you whether the NPI is active or deactivated.
This term refers to the address that is linked with NPI. it may contain a primary address, mailing, or secondary address.
Taxonomy code classifies the term, variety, and/or domain of a health care provider. Health care providers have been given an opportunity to select more than one code, but one must be primary.
- Other Identifiers
This category compares the NPI of Medicare and Medicaid or other insurers to assist in health plans and help in recognizing the provider.
- Endpoint information
Under this field, inside that, there is the direct information or a website of a provider. This field may also include content type, use, and endpoint details.
NPI also safeguards your service trademark and builds credibility. It can also help in preventing fraud, and standardizing this process of NPI is the major element and minimizing fraud. Either to validate the Service provider identity. It also helps determine the matching of patients of providers, their choosing equipment, and which service they are providing via which channel.
Healthcare is an essential part of life and is a pillar of success. But providing healthcare service and taking care of the patient is a way to expert work that only specialized people who have a certain knowledge of that domain in which they are serving. Making all procedures in the healthcare industry and medical profession, the unique identification code is being provided by HIPAA named “NPI.”
NPI consists of a 10-digit unique identity number like a bar code on a box. Concluded above detail in one package, NPI can give the healthcare service provider credibility to help their patients experience more versatile knowledge of health and medications. Who needs an NPI number? Non-physician or nurses can only be issued by NPI when they pass from specific specializations which require obtaining NPI.