Useful Advices - Business

What is an NPI? NPI or the National Provider Identification number is a 10-DIGIT unique numbers. It is a combination of intelligent numbers that does not carry information about the healthcare provider such as his provider type, spe

According to USFDA, a combination product is one composed of any combination of a drug and device; biological product and device; drug and biological product

cialty or in what state he is practicing. This unique identifier will eventually replace all of the provider’s insurance individual provider number issued by each insurance company that he participates with. But this will NOT replace the provider’s

; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.

Examples of combination products may in

ax ID Number which is required on claims submission.

NPI number once issued will remain permanent to the provider regardless of change in practice location, group practice or change of job.

NPI or the National Provider Identification number has be

lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.

n mandated by the Federal Government through HIPAA (Health Insurance Portability and Accountability Act of 1996. This must be obtained by health providers from the Centers of Medicare & Medicaid (CMS). This mandates all covered entities effective Ma

here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe

23, 2007.

So Why Do I need an NPI?

It is a standard and unique identification number for all providers (this also eliminates all your individual insurance provider number);
Fo

d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.

Combination pro

electronic submission of claims on HIPAA standard transactions

For HIPAA standard transaction on Benefits and Eligibility Inquiry

For HIPAA standard transaction on Claims Status Inquiry

For HIPAA standard transaction on Coor

ucts have become life saving products for the pharmaceutical companies who doesn’t have many innovative molecules in their product pipeline and have been inc

ination of Benefits

NPI is also required for the new HCFA 1500 08/05

Here's the Scenario:

A Pain Management Physician's group with one Physician Assistant and

easingly used in the product life cycle management. Even the companies having product patents are trying to extend their product life cycle through the combi

two Physical Therapists.

The Physician performs interventional pain management procedures in the following location:

POS (Place of Service): 11 (Office)

POS (Place of Service): 22 (Outpatient Hospital)

POS (Place of Service): 24 (Ambulatory Serv

nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically

ce Center)

What You Need:

Your Pain Management group/practice/company must have its own NPI number
The Physician must have its own NPI number
The Physician Assistant an

and physically. They need to rightly judge the benefits of the combination products and they have to even look at the risks involved when combining the produ

the two Physical Therapists must have its own NPI number

When billing on HCFA 1500 08/05:

Rendering Physician: Item Box 24J must have

ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi

he rendering provider's NPI number (eg. the MD, PA or the PT)

Service Location: Item Box 32a Must have the group / practice / facility NPI number

eg. Pain No More Group's NPI number (POS: 11) ASC Surgical Center (POS: 24) Great Ca

ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.

Following aspects would a

re Hospital (POS: 22)

So if the provider for example performed an SI injection done in the outpatient hospital service location, your HCFA 1500 Item Box 32a must have the NPI number of the outpatient hospital. The same way if the procedure was perf

dd to the challenges in developing combination products:

Which markets to tap where the combination products can do fairly well?
Which combination prod

remed at the ASC, you need the ASC's NPI number on box 32a.

Name of Referring/Ordering Provider: Item Box 17b Referring Provider's NPI number is placed here (this NPI number replaces UPIN after May 2007)

**It is now a good idea to

cts are meaningful and rational?
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin

start gathering NPI numbers for all your referring/ordering physicians NPI number for your new patients.

Billing Provider: Item Box 33a eg. Your Pain Management Group's NPI number

tions increase the patient compliance?
What would be the developing cost?
How to tackle the risks encountered during combination product developmen
g>

So Who are Affected with NPI? All Physicians and other medical practitioners, such as dentists, physical therapists, ophthalmologists, clinical psychologists, licensed social workers, physician assistants, nurse practitioners, n
t?

As combination products don't fit into the traditional categories of drugs, medical devices, or biological products, the USFDA is in the process of devel
rses, chiropractors, pharmacists and all medical specialists, etc.

Medical Practice Groups
HealthCare Provider Organizations/Companies/Service Locations
DME (durable medical equipment) vendors
Hospitals, nursing home
ping new procedures for reviewing their safety, efficacy and quality.

Professional from academic institutions, pharmaceutical industries, health care indust
and other institutional providers
Pharmacies All Health Plans (all HIPAA-covered entities) *** Small Health Plans has until May of 2008 to adopt NPI.

For your information: The
y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products
dministrative Simplification Compliance Act (ASCA) mandates that all providers must submit claims by electronic submission. Certain criterias must be met if you want to submit claims by paper only or both paper and by electronic. If you qualify and
.

As there is an increasing trend of the combination products companies manufacturing such products should be able to tackle the problems involved in the de
llowed to file paper claims, you may use the new CMS 1500 08/05 claim form. You must begin submitting the NPI number along with your legacy number as of January 2, 2007.

May 23, 2007 is the deadline for NPI! Don't waste time!

Apply for your NPI no
elopment. They need to be wiser in analyzing the market trends and the regulatory requirements.

Companies that provide selfless information through particip
. There will be transition for sure. Avoid the possibility of interrupting your claims payments from payers. Review your medical practice billing system, contact a clearing house or a billing service provider or vendors to discuss NPI implementation

tion in industry events and feedback to regulatory authorities would be able to face the challenges and will be successful in developing combination products

Tags

Links

Useful Advices - Why Do I Need An NPI? How Many NPI Numbers Do I Need? All About Billing With Your NPI

Related Articles: