WASHINGTON – The Centers for Medicare and Medicaid Services will review national provider identifier protocols that now require separate numbers for each covered entity. The requirement could mean some physicians who are also part of group practices and other arrangements would have multiple NPI numbers.

At a meeting of the Practicing Physicians Advisory Council, members brought the issue to the attention of CMs' director of program integrity, Kimberly Brandt. She said the goal is to have fewer numbers –not more. “So I appreciate your point, and it's a very good one,” she said. “And that's something I will definitely look into.”

PPAC member Barbara McAneny, M.D., an oncologist from Albuquerque, suggested the review as part of a draft recommendation approved by the council. The recommendation suggests CMS clarify which current provider numbers would be replaced by the NPI number and which entities would need their own numbers.

Dr. McAneny also suggested CMS “put pressure” on other groups, including state licensure boards, “to eliminate some of the numbers and not to just add them on and add them on and add them on. …”

NPI enrollment began May 2 and continues through May 2007, when all providers will be required to use the system for standard electronic health care transactions. “With national standards and identifiers in place for electronic claims and other transactions, health care providers will be able to submit transactions to any health plan in the United States,” CMS Administrator Mark McClellan, M.D., said in a May letter to health care providers.

As a requirement of the Health Insurance Portability and Accountability Act, many health plans–including Medicare, Medicaid, private health insurance issuers, and health care clearinghouses–must use NPIs in standard transactions by May 2007. Small health plans have an additional year to comply. The number is intended to replace current numbers, including the unique physician identification number (UPIN).

Ms. Brandt told the advisory council that CMS is conducting a “massive outreach effort” to inform providers of the change and encourages them to apply for an NPI. Applications can be made electronically or through the mail. To demonstrate the process of getting an NPI, PPAC Chairman Ronald Castellanos, M.D., got his number at the council's meeting, in a process that took approximately 8 minutes. “I'm not bleeding,” Dr. Castellanos said when asked how painful the process was.

CMS is encouraging health plans to devise a transition plan for a system that accepts both the UPIN and NPI until the May 2007 compliance deadline. Ms. Bryant said that although a few health plans already have systems developed, most do not–including Medicare, which she said will not have the “capacity to be fully changed over” until 2007.

“We need the next year and a half to finish getting our claims-processing system completely converted over, and then we'll begin the phase-out I would say about 6–8 months ahead” of the May 2007 deadline, she said. CMS is recommending that members of groups not sign up individually now but wait until fall, when “batch enumeration” systems will be in place to accept group applications.

Once assigned a random NPI, providers will have that number for the remainder of their careers and need only contact CMS to make changes. The system will be meshed with Social Security information to track provider deaths, and the agency hopes to be able to coordinate with state licensing groups as well, Ms. Brandt told the council.

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PPAC member Dr. Geraldine O'Shea applied for her national provider identifier number during a break at a recent council meeting. Vivian E. Lee

Please, Can We Have a Directory?

Security concerns are currently keeping CMS from developing a directory of all NPI numbers for all health providers and covered entities, but one may be developed in the future, Ms. Brandt told PPAC members.

“We may get to a point where we have a directory, but right at the moment, we don't have a [list] like the unique physician identification number directory in the works,” she said.

Instead, the agency is planning to publish in the Federal Register in October a notice on how NPIs can be obtained from other health care providers and covered entities.

PPAC members encouraged Ms. Brandt to look into a directory for referring physicians, even if such a directory turned out to be a subscriber service. “I would strongly advocate that you [develop a directory] even if there's a subscription fee because one of the more problematic things when you bill for a consult is to try to track down Dr. Jones' [UPIN], and it's a significant hurdle and a big burden on the practice,” said surgeon Anthony Senagore, M.D., of the Cleveland Clinic Foundation.

Ms. Brandt noted that an encrypted or password-accessed system would be necessary, given that “people have been able to get access to [the UPIN director] who shouldn't have been able to get access to it.” Council members' recommendation for a subscription fee or encryption is “a good one,” she said.

Physicians Are Hoping for a CMS Revision on NPI Numbers