National HIPAA Audioconference: Analysis of the National Provider Identifier

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National HIPAA Audioconference Analysis of the
National Provider Identifier

• Steven S. Lazarus, PhD, CPEHR, CPHIT, FHIMSS
• President
• Boundary Information Group
• www.boundary.net
• January 11, 2006

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Steve Lazarus.Boundary Information
GroupStrategies for workflow, productivity,
quality and patient satisfaction improvement
through health care information

• Strategic IT business process planning
• ROI/benefits realization
• Project management and oversight
• Workflow redesign
• Education and training
• Vendor selection and enhanced use of vendor
  products
• Facilitate collaborations among organizations to
  share/exchange health care information

• Business process consultant focusing on
  electronic health records, and electronic
  transactions between organizations
• Former positions with MGMA, University of Denver,
  Dartmouth College
• Active leader in the Workgroup for Electronic
  Data Interchange (WEDI)
• Speaker and author (two books on HIPAA Security
  and one on electronic health records)
• Co-Founder of Health IT Certification

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History of NPI

• 1993 WEDI Report recommended four Standard
  Identifiers
• Patient
• Provider
• Payer
• Employer
• 1996 HIPAA legislation includes these four
  identifiers
• 1998 National Provider Identifier NPRM
• 2004 National Provider Identifier Final Rule
• May 2007 NPI use required by all CEs except small
  health plans (May 2008)

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Simple NPI The Vision

• Most health care providers receive one unique
  number for life
• No cost to apply for the number
• All health plans must use the number and stop
  requiring proprietary numbers by May, 2007 (May,
  2008 for small health plans)
• NPIs are obtained from NPPES (NPPES.cms.hhs.gov/NP
  PES/WELCOME.do)
• Provider NPI application process
• NPI dissemination to health plans and others

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Types of NPIs

• Type 1 Individual NPI An individual health
  care provider may obtain a single NPI to identify
  the person for life
• Type 2 Organizational NPI is a provider that is
  not an individual. It is a legal entity such as
  government, corporation, partnership. It obtains
  one NPI for the whole, and it may obtain NPIs for
  its Subparts.

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What are the Barriers?

• Obtaining the numbers
• Only a few hundred thousand numbers issued so far
• Bulk enumeration not available yet
• Distributing the NPIs
• Health plans, hospitals and others need to access
  the new numbers
• Information processing issues
• Matching current provider/identifier to the NPI
• Designing and implementing new data flows and
  uses without proprietary number
• Determining subparts (for Medicare) and their
  Type 2 NPIs

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NPIOI

• WEDI established the National Provider Identifier
  Outreach Initiative in 2005
• Established the WEDI National NPI Resource Center
• www.wedi.org/NPIOI/index.shtml

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Contact Information

• Steven S. Lazarus, PhD, CPEHR, CPHIT, FHIMSS
• President
• Boundary Information Group
• [phone]
• sslazarus_at_aol.com
• www.boundary.net
• www.healthitcertification.com