One of the most common mistakes in medical billing and rejected claims is a missing or incorrect NPI number. Without a correct NPI number, no insurance claim submitted to Medicare, Medicaid, or any health plan is paid or resolved.
The majority of doctors and other healthcare professionals are familiar with the term NPI as it is used regularly to authenticate and verify a wide range of individual claims, authentication, insurance claims, process control, contracts, agreements, and more.
An NPI number also referred to as the National Provider Identifier, is a 10-position, intelligence-free unique identification number. It is issued to doctors and all other healthcare providers and organizations in the United States. This means that the data won’t include any further information about healthcare professionals, including their location or what medical specialty they practice. NPI numbers are meant to improve the efficiency of health records and medical data.
NPI numbers were first introduced in 1996 as part of the Health Insurance Portability and Accountability Act (HIPAA). Moreover, the NPI number is used over the conventional provider identification in HIPAA standards transactions. Besides, it is used by the Centre for Medicare, Medicaid Services (CMS), and other healthcare plans and clearinghouses to issue insurance or payment claims and other financial and administrative transactions.
Who Needs an NPI Number?
Any healthcare professional, healthcare clearinghouse or healthcare institution that undertakes transactions or uses public health records that fall under HIPAA regulations is needed to get an NPI. This also includes companies and healthcare providers that use a medical insurance company to process their medical claims.
HIPAA mandates that any person, company, or healthcare institution that transmits any electronic patient medical data in lieu of a transaction is required to have an NPI number. Once a provider gets their NPI, it cannot be modified and remains with them irrespective of their position or their work or residential location.
You can apply for an NPI as a solo massage therapist, or, if you’ve established an LLC or other business entity for your massage business, you can get one for your business.
How is an NPI Used?
An NPI number is a unique identifier for each healthcare provider or entity. It is required to be used by all healthcare plans for every administrative and financial transaction. Healthcare plans are used to allocate their own NPI numbers to each healthcare provider. The aftermath was that every provider had to use a different identification number based on which health plan they were submitting claims to. The standard NPI number has made issuing claims and tracking them more efficient and easy.
The NPI number is used with any transaction identified according to HIPAA standards. It may also be used by medical professionals to identify themselves or other members in healthcare transactions or related things. For example, it may be used by health plans in their transactions and communications to identify medical professionals and other providers in electronic patient health records. It could also be used by physicians on prescriptions to sync benefits with other medical plans. Additionally, it could be used by the Department of Health and Human Services to track providers in abuse and fraudulent cases.
Why Should You Get an NPI as a Massage Therapist?
The NPI is your official unique identification number in health-related billing claims, including those reimbursed by Medicaid, Medicare, and other insurance plans. It allows you to get payments from insurance claims when treatment is covered by a patient’s insurance plan. This consists of massages since the majority of health plans are now starting to cover it as a treatment for different conditions, including mental illnesses and chronic pain.
Even if a massage therapist does not bill directly for services, and they work with companies that do submit HIPAA-covered claims, they may need an NPI. For instance, this scenario is valid with appointments with Zeel.
As of 2007, massage therapists have the alternative to apply for an NPI number. Other healthcare providers- including doctors, physical therapists, and dentists- also apply for and get NPIs.
What Does an NPI Number Not Do?
An NPI number cannot do the following:
- Ensure payment by a health insurer or healthcare plan.
- Allocate you in a health plan.
- Replace other licenses or credentials.
How Much Does an NPI Cost for Massage Therapists?
For massage therapists or other healthcare providers, NPIs are obtained free of cost.
Even if you change your location or areas of practice, your NPI would remain the same. Your NPI number would never expire, which means you do not need to get it replaced with a new one if you already have it. This is why there’s no reason to renew it, regardless of where or by whom you’re employed.
How Long Does it Take to Obtain an NPI?
The Centres for Medicare and Medicaid Services (CMS), or your issuing agency, claims that a correctly filled application should take a massage therapist no longer than 10 business days to obtain an NPI number.
While this is the guidance provided by CMS, massage therapists who already have applied for NPIs in recent times have reported getting one in as little as one business day.
It is important to note that the CMS does not send an email reminding you when the NPI is issued. All you have to do is go to their website and simply check after you apply.
How Can Massage Therapists Apply for NPIs?
As massage therapists, applying for NPIs is very simple and takes no longer than 15 minutes to fill the application. All you need to do is to visit the NPPES website, follow the instructions provided, complete the questionnaire, and finally submit your application.
In case you need assistance, the website contains a section of frequently asked questions and other helpful information.
The Bottom Line
NPI numbers are very important for precise medical billing, handling insurance claims, and accelerating revenue cycle management.
As NPI numbers are required by HIPAA regulations to check healthcare services and payment reimbursements, any medical claim submitted without a properly registered NPI number will be denied by health plans.