The NPI is part of the
requirements imposed on the health care system by HIPAA. It
can affect every athletic trainer regardless of setting
unless you plan on retiring in the next 18 months or so.
EVERY athletic trainer should get their NPI today.
What is the NPI?
Today, health plans assign
identification numbers to health care providers --
individuals, groups, or organizations that provide medical
or other health services or supplies. The result is that
providers who do business with multiple health plans have
multiple identification numbers. The NPI is a unique
identification number for health care providers that will be
used by all health plans. Health care providers and all
health plans and health care clearinghouses will use the
NPIs in the administrative and financial transactions
specified by HIPAA. Even if you currently do not work in a
setting that bills health care plans today, what is to say
you won’t in the future? The NPI contains no embedded
intelligence; that is, it contains no information about the
health care provider such as the type of health care
provider or State where the health care provider is located.
Who needs an NPI?
NPIs are given to health care
providers that need them to submit claims or conduct other
transactions specified by HIPAA. A health care provider is
an individual, group, or organization that provides medical
or other health services or supplies. This includes
physicians and other practitioners, physician/practitioner
groups, institutions such as hospitals, laboratories, and
nursing homes, organizations such as health maintenance
organizations, and suppliers such as pharmacies and medical
supply companies. This does not include health industry
workers, such as admissions and billing personnel,
housekeeping staff, and orderlies, who support the provision
of health care but do not provide health care services.
How are the NPIs going to be used?
The NPI must be used in
connection with the electronic transactions identified in
HIPAA. In addition, the NPI may be used in several other
ways: (1) by health care providers to identify themselves in
health care transactions identified in HIPAA or on related
correspondence; (2) by health care providers to identify
other health care providers in health care transactions or
on related correspondence; (3) by health care providers on
prescriptions (however, the NPI could not replace
requirements for the Drug Enforcement Administration number
or State license number); (4) by health plans in their
internal provider files to process transactions and
communicate with health care providers; (5) by health plans
to coordinate benefits with other health plans; (6) by
health care clearinghouses in their internal files to create
and process standard transactions and to communicate with
health care providers and health plans; (7) by electronic
patient record systems to identify treating health care
providers in patient medical records; (8) by the Department
of Health and Human Services to cross reference health care
providers in fraud and abuse files and other program
integrity files; (9) for any other lawful activity requiring
individual identification of health care providers,
including activities related to the Debt Collection
Improvement Act of 1996 and the Balanced Budget Act of 1997.
How do I get an NPI?
The quickest way is to go the
following web site and fill out the application on line
https://nppes.cms.hhs.gov and follow the prompts.
We are listed
under the Respiratory,
Rehabilitative and Restorative Service Providers
section, just in a sub-section of that area. The placement
of our position has nothing to do with an ATCs education,
abilities or qualifications. In fact the placement of ATCs
in the specialist technician sub-category requires more
education then placement in the more general area. No one
should imply that because we are not listed in the general
area that we are perceived as being less qualified.
(Remember the government is involved)
Why is it important I get an NPI when I don’t bill for
services?
1) These numbers are for medical
professional, you are one. 2) Just because you might be
working in an environment or state where you don’t bill for
your services today doesn’t mean you won’t tomorrow. 3) If
you are billing for your services you won’t be able to
unless you have an NPI.
