National Provider Identification System

Copies and summaries of the proposed rules.

 
~ SUMMARY of NPI if implemented as Proposed Rule ~
 
¥ Providers Defined: "All persons licensed, certified or otherwise authorized to perform medical services or provide medical care, equipment and/or supplies in the normal course of buiness" (MD, RN, DDS, DC, PT, OT, RhD, etc.) and health care facilities (hospitals, laboratories, ambulance companies, HMOs, pharmacies, nursing homes, etc.) and groups (physician group practices) will be required to apply to the federal government for a national provider identification number (NPI)
 
¥ Who's First? The federal government will begin enumerating participating providers in Medicare and Medicaid first.
 
¥ Ability to Practice: No electronic health care transaction could take place without the NPI. Minnesota task force participants are asking that paper transactions require the NPI as well.
 
¥ Enumeration through "Enumerators": A new federal registry, private organizations, Medicare or Medicaid agencies, designated state agencies, health plans, or a combination. Options for the Registry: 1) a single Federally-directed registry or 2) a linked combination of health plans, Medicaid agencies, and Federally-directed registries. DHHS claims the system holds a capacity for 20 billion unique NPIs.
 
¥ Data Included on Registry: NPI, Social Security Number, Employer Identification Number, birth date, birth state code, birth county and country, current name, other name, legal business name, name suffix, credential designation, sex, race, date of death, mailing address, telephone number, fax number and e-mail, resident/intern code, enumerate date, update date, enumerator/agent number, classification, certification code, certificate number, license number, license state, group member name,organization type control codes, other provider numbers, school code, name, city, state, country, and graduation year, and practice location code,name, address, telephone number, fax, and e-mail.
 
¥ Data Updates: updates must be forwarded to the database within 60 days by each provider. Non-compliance penalties pending.
 
¥ Penalties: "Failure to comply with standards may result in monetary penalties. The Secretary is required by statute to impose penalties of not more than $100 per violation on any person who fails to comply with a standard, except that the total amount imposed on any one person in each calendar year may not exceed $25,000." Enforcement procedures will be outlined in future federal rule proposals. Since this is an unfunded federal mandate, some members of a Minnesota NPI working group commented that non-compliance penalties may assist in financing the enumeration process.
 
¥ Effective Date: 24 months after the effective date is listed in the Federal Register (likely late 2001).
 
 
Possible Ramifications