If you're a psychologist who bills insurers electronically for payment and you haven't already applied for your National Provider Identifier (NPI), time is running out. The deadline for applying for the 10-digit NPI, a unique number assigned to every health-care provider or entity for electronic billing procedures, is May 23.
Applying for an NPI is part of complying with the requirements of the Health Insurance Portability and Accountability Act (HIPAA). Even if a psychologist doesn't use electronic billing, insurance providers are increasingly moving toward electronic systems and will want practitioners to have an NPI, says Russ Newman, PhD, JD, executive director of the APA Practice Organization.
The NPI replaces other provider identification numbers the government and private insurers have assigned to health-care providers, such as Medicare's Unique Physician Identifier Number (UPIN). Under HIPAA, federal law requires all "covered entities" to get an NPI. To find out if you're a "covered entity" under HIPAA, see the HIPAA compliance section of APApractice.org. Additionally, private insurers can require that enrolled health professionals use an NPI, even if they bill by mail rather than electronically. For that reason, the APA Practice Organization encourages all psychologists who bill any private or public health insurance plan, including federal and state programs, to obtain an NPI.
Psychologists can complete and submit the NPI application form through the Centers for Medicare and Medicaid Services (CMS) at https://nppes.cms.hhs.gov. To complete the application, psychologists must provide:
Date and country of birth, as well as state of birth, if born in the United States.
Social security number or for those not eligible for an SSN, an individual taxpayer identification number.
Practice location and telephone number.
State license information-only required for certain kinds of specialties, as listed by individual taxonomy code.
Business contact name, phone number and e-mail address.
According to CMS, a health-care provider submitting a properly completed electronic application should have an NPI in 10 days.
Changes to taxonomy codes
When applying for an NPI, psychologists are asked to list a taxonomy code, a 10-digit alphanumeric identifier describing a practitioner's health-care practice and professional services. The NPI assigned to a provider doesn't reveal that practitioner's choice of taxonomy codes, but insurance providers will be able to ask practitioners for them. There are two main taxonomy codes for psychologists: psychologist and clinical neuropsychologist. Under psychologist, there are 17 active specialty codes psychologists can choose from to further describe their practice.
APA was not included at the outset in developing the psychology-related codes for the taxonomy code list. The association took its concerns about the codes to the National Uniform Claim Committee (NUCC), the organization involved with implementing and refining them. For example, Newman notes, APA challenged the use of specialty codes as being inappropriate for psychology. The APA Practice Organization has worked with the NUCC over the past year to update codes so that they better represent how psychologists typically practice, Newman says.
When evaluating the taxonomy codes, the APA Practice Organization expressed concern over their shortcomings in describing the discipline of psychology as it's actively practiced, Newman says. The APA Practice Organization argued for a number of changes, such as inserting a comprehensive definition of psychology and making deletions, additions and changes to code names, to better reflect the work done by psychology practitioners.
And it's not the existence of the taxonomy codes per se that's the specific worry, but concern over how they might be used by insurance companies, Newman says.
"The real issue here is having this information in the hands of insurance companies, and them using that information to make reimbursement decisions," he says.
The NUCC took over the maintenance of the code list in 2001 from a previous group that developed the list, says Nancy Spector, chair of the NUCC and director of electronic medical systems.
As Spector sees the discussions with APA staff over the past year, both sides learned a lot in the process of working through changes to the codes.
NUCC staff learned that within the discipline of psychology, what are listed as specialties in the taxonomy code set are seen more as areas of focus - and APA staff learned more about how the codes were developed and how they're being used, Spector says.
"I think we've come to a conclusion that is a really good list of psychology codes for the taxonomy code set, and we've got something that as we move forward and continue to work, we can improve even more," Spector says.
A step forward
Some of the additions made to the taxonomy codes are a "real step forward" for psychology, such as a new code for prescribing psychologists, Newman says. That addition was achieved in part through the efforts of Glenn Ally, PhD, MP, a clinical neuropsychologist and one of 33 "medical psychologists" certified and authorized to prescribe psychotropic medications in Louisiana.
Representing the Louisiana Academy of Medical Psychology, Ally argued for a new taxonomy code to represent psychologists who are authorized to prescribe psychotropic medications. The Practice Directorate worked with the NUCC to achieve a new code called "Prescribing (Medical)," given that prescriptive authority for certified psychologists is a developing specialty within the discipline.
"I think there will be a significant number of psychologists [prescribing] in the future, and I want this in place now, rather than having to go back and change things later," Ally says.
Working with the NUCC, the APA Practice Organization also secured approval of the following changes to the taxonomy codes:
Combined "clinical neuropsychologist" and "neuropsychologist" into one category called "neuropsychologist."
Deleted the "Men and Masculinity, Women, Education, Psychotherapy" codes-eliminating codes that didn't reflect recognized specialties within psychology, or contained focus areas included in other codes. (Psychologists with an NPI who chose a taxonomy code that's recently deleted may want to select a different code. The codes are listed at www.wpc-edi.com/codes/taxonomy.)
Changed the "Behavioral" code to "Cognitive and Behavioral"; the "Child, Youth and Family" code to "Clinical Child and Adolescent"; and "Psychotherapy, group" to "Group Psychotherapy"-alterations that cut down on duplicative codes and more accurately reflect how the specialties are described by professionals within the discipline, according to APA Practice Organization staff.
Added a "Health" code back onto the list, given its nature as a developing specialty within psychology.
The APA Practice Organization will monitor how insurance companies use the taxonomy codes, Newman says.
"If there's information that is being inappropriately used, we'll need to aggressively deal with that," he says.
For more on the NPI, visit APA Practice.