The ASHA Leader - February 2015 - 32

On THe jOb

BOttOM LiNe

The National Provider Identifier:
Separating Fact From Fiction
What you need to know to establish-and protect-your identity as a health care provider.
By Lisa satterfieLd

All health care providers-including
audiologists and speech-language
pathologists-need a National
Provider Identifier to bill for their
services. But as the use of electronic
health records expands and more
people are getting health insurance
coverage, the potential for insurance
fraud and identity theft through
a provider's NPI also increase.
Clinicians need to understand
the facts-and the myths-about
obtaining an NPI and protecting
their provider records.

The myths
Only audiologists and sLPs who
work in health care settings need
an NPi.
It is true that the NPI is used
in health care facilities to bill
health insurers-Medicare,
Medicaid, private plans, workers'
compensation. But increasing
numbers of local education agencies,
schools and universities are also
billing insurance plans for services.
Generally, every provider who is
involved in health care needs an NPI,
regardless of where the services are
provided. School-based providers
should check with their local districts
about the need for individual NPIs
(on.asha.org/npi-medicaid).
Once i have my NPi, that's all i need
to bill Medicare.
Getting your NPI is only the first
step in billing insurance. Many
insurers, including Medicare,
Medicaid and many private insurers,
require you to enroll or complete a
credentialing process. Audiologists
and SLPs who want to become
32

February 2015 |

THe aSHa Le aDer

in theory, NPis are publically available and could be
used by someone else. However, the information
that is available to the public does not include social
security numbers or other personal identification
needed for insurance enrollment.
Medicare providers first need an
NPI, then must complete the online
Medicare enrollment at https://
pecos.cms.hhs.gov.
i don't need an NPi because i
work for a physician or i am a
clinical fellow.
Everyone who delivers direct patient
services should have an individual
NPI. Outpatient Medicare claims
require the NPI of the providing
clinician for each service provided.

Medicare requires that claims
for hearing and balance services
provided by an audiologist include
the audiologist's NPI as the rendering
provider. Clinical fellows in states
with licensure can obtain an NPI
using the speech-language pathology
provider taxonomy code (see next
page) and enroll in Medicare.
Students and clinical fellows in
states without licensure can obtain
a student NPI using the provider
taxonomy number 390200000X.



http://on.asha.org/npi-medicaid https://pecos.cms.hhs.gov https://pecos.cms.hhs.gov

The ASHA Leader - February 2015

Table of Contents for the Digital Edition of The ASHA Leader - February 2015

Contents
The ASHA Leader - February 2015 - Intro
The ASHA Leader - February 2015 - Cover1
The ASHA Leader - February 2015 - Cover2
The ASHA Leader - February 2015 - Contents
The ASHA Leader - February 2015 - 2
The ASHA Leader - February 2015 - 3
The ASHA Leader - February 2015 - 4
The ASHA Leader - February 2015 - 5
The ASHA Leader - February 2015 - 6
The ASHA Leader - February 2015 - 7
The ASHA Leader - February 2015 - 8
The ASHA Leader - February 2015 - 9
The ASHA Leader - February 2015 - 10
The ASHA Leader - February 2015 - 11
The ASHA Leader - February 2015 - 12
The ASHA Leader - February 2015 - 13
The ASHA Leader - February 2015 - 14
The ASHA Leader - February 2015 - 15
The ASHA Leader - February 2015 - 16
The ASHA Leader - February 2015 - 17
The ASHA Leader - February 2015 - 18
The ASHA Leader - February 2015 - 19
The ASHA Leader - February 2015 - 20
The ASHA Leader - February 2015 - 21
The ASHA Leader - February 2015 - 22
The ASHA Leader - February 2015 - 23
The ASHA Leader - February 2015 - 24
The ASHA Leader - February 2015 - 25
The ASHA Leader - February 2015 - 26
The ASHA Leader - February 2015 - 27
The ASHA Leader - February 2015 - 28
The ASHA Leader - February 2015 - 29
The ASHA Leader - February 2015 - 30
The ASHA Leader - February 2015 - 31
The ASHA Leader - February 2015 - 32
The ASHA Leader - February 2015 - 33
The ASHA Leader - February 2015 - 34
The ASHA Leader - February 2015 - 35
The ASHA Leader - February 2015 - 36
The ASHA Leader - February 2015 - 37
The ASHA Leader - February 2015 - 38
The ASHA Leader - February 2015 - 39
The ASHA Leader - February 2015 - 40
The ASHA Leader - February 2015 - 41
The ASHA Leader - February 2015 - 42
The ASHA Leader - February 2015 - 43
The ASHA Leader - February 2015 - 44
The ASHA Leader - February 2015 - 45
The ASHA Leader - February 2015 - 46
The ASHA Leader - February 2015 - 47
The ASHA Leader - February 2015 - 48
The ASHA Leader - February 2015 - 49
The ASHA Leader - February 2015 - 50
The ASHA Leader - February 2015 - 51
The ASHA Leader - February 2015 - 52
The ASHA Leader - February 2015 - 53
The ASHA Leader - February 2015 - 54
The ASHA Leader - February 2015 - 55
The ASHA Leader - February 2015 - 56
The ASHA Leader - February 2015 - 57
The ASHA Leader - February 2015 - 58
The ASHA Leader - February 2015 - 59
The ASHA Leader - February 2015 - 60
The ASHA Leader - February 2015 - 61
The ASHA Leader - February 2015 - 62
The ASHA Leader - February 2015 - 63
The ASHA Leader - February 2015 - 64
The ASHA Leader - February 2015 - 65
The ASHA Leader - February 2015 - 66
The ASHA Leader - February 2015 - 67
The ASHA Leader - February 2015 - 68
The ASHA Leader - February 2015 - 69
The ASHA Leader - February 2015 - 70
The ASHA Leader - February 2015 - 71
The ASHA Leader - February 2015 - 72
The ASHA Leader - February 2015 - Cover3
The ASHA Leader - February 2015 - Cover4
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https://www.nxtbook.com/nxtbooks/asha/leader_mediakit2015
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https://www.nxtbook.com/nxtbooks/asha/leader_1014
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