The government in the US brought in legislation that mandated health care providers to get a ten-digit unique identifier for ease of administration. The NPI, which is a short form for the National Provider Identifier, has replaced the erstwhile Unique Physician Identification Number.
The NPI registry is a vital source of data for all databases that provide information about the healthcare system in the US. In this article, you will get to know what exactly is the NPI number and why it is useful.
What Is The NPI Number?
A 2007 legislation in the US ushered in the era of a unique identifier for all healthcare providers. The biggest utility of the unique identifier was to avoid duplication and confusion in administrative work.
Here is a list of professionals who are mandated to use the NPI number:
● All physicians, including dentists, opticians, chiropractors, etc.
● Healthcare agencies like hospitals, nursing homes, clinics, etc. These agencies hire several people associated with the healthcare system, and if they are to transact with healthcare providers, they, too, should have an NPI themselves.
In fact, NPIs are classified into two types depending on if they are to be used by an individual like a doctor or by a group or an entity like a hospital. So hospitals have a type 2 NPI.
● Pharmacists, pharmacy technicians, pathological laboratories, etc.
Here is a list of people who are somehow associated with the healthcare system yet are not legally mandated to get an NPI number for themselves
● Housekeeping staff at a hospital or a clinic.
● A person who works as a receptionist at a hospital.
Some of the unique features of an NPI are that they are permanent. So once a ten-digit unique number has been assigned to you, it will remain yours for the rest of your life irrespective of the factors like change in location, change in job profile, etc.
The Advantages Of Having An NPI
NPI Helps In Easy Coordination Of Benefits
The advantage of having one unique digital identity for one person instead of multiple identities for a single person is that it reduces duplication, and this improves the efficiency of transactions. For instance, if a healthcare provider is to be covered under some government scheme that mandates an automatic exclusion for another scheme.
In such a case, a unique digital identifier will automatically exclude a particular NPI( individual) from the benefits of any other scheme once he is registered for one type of scheme. This will ensure that the same person does not get an undue advantage by registering under multiple government schemes.
Thus, the NPI number helps in reducing the wasteful expenditure of precious government revenue, and this, in turn, is beneficial for the federal exchequer.
The unique identifier also helps create a standardized transaction system that is smooth and efficient. Since there is one identifier for one individual, there is no need for multiple rounds of cross-verifications and delays in clearing funds or getting approvals from the administration.
NPI Helps In The Easy Identification Of Providers In Cases Of Medical Fraud And Drug Abuse
A unique number for each healthcare provider is a great way to trace a particular healthcare provider. So in case this is a fraud or mismanagement of hospital drugs leading to drug abuse, NPI can be of great help.
If there is a misuse of drugs, false signatures on prescriptions, etc., law enforcement agencies will be able to quickly trace the doctor or the pharmacist from whose end the problem emerged. However, if a doctor or a pharmacist purposely types in the wrong number, a whole lot of problems could emerge, and then tracing leakages will be challenging.
NPI Helps In Maintaining Statistical Records
Many healthcare databases collect data from various sources and make them available to businesses, government agencies, and also individuals for further analysis. Most of these organizations collect data from open-source sources.
NPI data is also a part of the healthcare database, and this data can be used for further research and analysis of the healthcare system. The freely available data from online databases can be used for state-wise analysis and can also help in generating comparative data.
NPI Helps Track Healthcare Providers
If individuals get access to a doctor’s NPI number, they can use it to trace that doctor. For instance, if you met a doctor in New Jersey and he was great for treating your allergies. If you somehow cannot spot him in the whole of New Jersey and if you have his NPI number, you can track him if he still practices in the US.
However, An NPI number is not the solution to all problems that plague the healthcare system. And here is a list of things that the unique digital identifier does not do
● It does not enroll a healthcare provider automatically to a new medical plan or scheme
● It does not guarantee the disbursement of payment under a health plan. So if your insurance or some sort of benefit is pending, do not expect the administration to magically speed up the process just because you have an NPI. However, in the long term, the unique digital identifier is expected to cut a lot of bureaucratic red tape and hasten the process of benefit or insurance disbursal.
● The NPI is not proof of your medical license or your competence as a doctor. The unique digital identifier is expected to make the work of administration easy, but it is in no way proof of your credibility and will not replace your medical license.
It has been over a decade since a unique digital identifier for healthcare providers was started by federal agencies in the US. Most administrations and the medical fraternity today realize the benefit of the ten-digit identifier.
Apart from healthcare providers and government agencies, the number has been of great help to audit bureaus, insurance companies, and researchers who want to analyze data related to the healthcare sector.