Safeguards needed for doctor ID numbers

The National Provider Identifier makes for an easier time filling out forms, but if CMS doesn't look out, it could make for an easier time preying on physicians.

Editorial. Oct. 2, 2006.

The good news is, soon physicians will need to use only one identification number on all of their government and private-sector claims. The bad news is, this convenience for doctors could make it more convenient for those who want to subject physicians to unwanted business pitches, fraud and identity theft.

The National Provider Identifier is a creation of the Health Insurance Portability and Accountability Act. It is a welcome alternative to the hassle of obtaining and keeping straight the jumble of different numbers required for every different plan.

Implementation of NPI is the responsibility of the Centers for Medicare & Medicaid Services. It is CMS that will be doing a great disservice to physicians and other health care professionals if it doesn't put the strictest of requirements on who gets access to this number.

On May 23, 2007, physicians will be required to have their NPIs in hand and to use them then on virtually all claims. Doctors can apply for an NPI right now from CMS, electronically or by mail. Some insurers already are allowing physicians to use the new number while other plans, such as Medicare, will accept it as of Jan. 1, 2007. The transition ends in 2008, when certain small plans come on board.

As of yet, CMS has not said who will get access to the National Provider and Payer Enumeration System (NPPES), which assigns the NPIs. Nor has it said how that information will be protected. CMS was expected to have issued some guidelines -- called a data dissemination notice -- by the summer, but that has been delayed for reasons not explained.