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Residents & Fellows May 18, 2017

A Quick Guide to Getting a NPI Number for Locum Doctors, Clinicians, Residents & Fellows

Getting a National Provider Identifier (NPI) number is a standard part of practicing medicine. Among other important elements, NPI numbers are required by every doctor. nurse, therapist, dentist, and another clinician who wishes to receive payment on Medicare/Medicaid claims.

NPI numbers are required by the Health Insurance Portability and Accountability Act, or HIPAA, as it's commonly known. More than twenty years after its implementation, HIPAA is widespread throughout America's healthcare industry. In an effort to standardize practices of care involving insurance, security, and fraud prevention, as well as facilitating a greater shift to electronic billing and record-keeping, HIPAA's regulations have been integrated into hospitals and healthcare systems of all shapes, sizes, and locations.

Assigned to every doctor, nurse, and clinician involved in HIPAA-related transactions, the NPI is a 10-digit numeric identifier that, according to the U.S. Centers for Medicare & Medicaid (CMS), is "intelligence-free." This means that "the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty." If you had a different identifier code before HIPAA, you're required to replace it with an NPI number.

Your NPI is yours "even if your employer files the application for it," according to the American Academy of Family Physicians (AAFP). "The NPI does not change when you change practices or work in different settings. You will have only one individual NPI. It will be used by all health plans who are covered entities."

Even if you're a clinician who doesn't bill for services, you "may need to disclose your NPI to those providers who do," like "providers who order lab tests or send patients for diagnostic testing must be identified on the lab's or testing facility's claims," explains the American Speech-Language-Hearing Association (ASHA). "Without the NPI, claims may be adversely affected, with payment delayed or possibly denied.

As the ASHA succinctly puts it, "getting an NPI is free," but "not having one could be costly."

Why Medical Residents Need to Get An NPI Number

The uses of NPI numbering is so widespread and standardized throughout healthcare that you may need to get a number as early as during your residency, fellowship, internship, or even when you're still a medical student — in any case where you may be required to transmit health data.

"If interns or residents prescribe medications for patients whose prescriptions are filled by pharmacies, refer patients to other health care providers, or order test for patients from other health care providers, those pharmacies and other health care providers will need to identify them as prescribers or as providers who referred patients or who ordered tests for patients," explains the Association of American Medical Colleges (AAMC). "While the NPI Final Rule might not require these providers to obtain NPIs, it may be necessary for them to have NPIs in order for the pharmacies and other providers to be reimbursed by health plans."

There's even a Healthcare Provider Taxonomy Code that exists for classifying students, interns, and residents who aren't yet licensed by a state. Because the code is defined in this way, the AAMC recommends that physicians should update their data in the National Plan and Provider Enumeration System (NPPES) "by submitting a change in the Healthcare Provider Taxonomy Code to reflect the change in status from medical student to physician" once they become licensed.

How to Get An NPI Number, Especially Locum Tenens

Most of the time, your NPI is set up and provided by your employer or school. However, in some instances — doctors and clinicians who have always worked in private practice, or have long worked for organizations that have been slow to become HIPAA compliant — you may find yourself in a situation where you need to get your own NPI number. And if you're just out of your residency, you may want to secure your new, licensed-status NPI before choosing a practice type.

For doctors and clinicians who live the locums' lifestyle, work may frequently involve a variety of settings and scenarios. You may or may not have to use your own NPI number when working assignments, depending on the length, location, and nature of the work. During assignments that last fewer than 60 days, the employer may choose to use the NPI of the doctor that you're replacing. For longer assignments, though, your own NPI will typically be required. It's a good idea to sign up for an NPI number if you don't have one already (or if you need to transition out of a residency, internship, or student classification).

Fortunately, the process to apply for an NPI number is fairly simple; the organization that runs the NPI application system, the National Plan and Provider Enumeration System (NPPES), estimates the time it takes to complete an application to be 20 minutes. You can apply on the NPPES website, here, or print out this application, and mail it to the address listed on the document. To complete the application, you'll need your current provider identification numbers, UPIN numbers, license numbers, and taxonomy codes (you can view the CMS taxonomy chart here). You can also request a paper NPI application by calling (800) 465-3203.

Resources On Getting A NPI Number Or Learning More

If you have any further questions about how to get an NPI number, we encourage you to get in touch with your Staff Care recruiter. You can also contact us via this quick form. And for even more industry advice and info, join us on social! We're on TwitterFacebookLinkedIn, and YouTube.

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