Tuesday, November 26, 2013

NPI: No Office = Bad For Lab

Yesterday a sadly familiar issue landed on my desk: how to make NPIs work for lab results.

NPIs were brought to you by CMS, so they have to be good.

To quote from The National Provider Identifier (NPI): What You Need to Know

How Many NPIs Can a Sole Proprietor Have?
A sole proprietor is eligible for only one NPI, just like any other individual. For example, if a physician is a sole proprietor, the physician is eligible for only one NPI (the individual’s NPI), regardless of the number of different office locations the physician may have, whether the sole proprietorship has employees, and whether the Internal Revenue Service (IRS) has issued an EIN to the sole proprietorship so the employees’ W-2 forms can reflect the EIN instead of the sole proprietorship’s Taxpayer Identification Number (which is the sole proprietor’s SSN).
This is logical, but it is very bad for clinical laboratories. Physicians practicing medicine do not fit the model of citizens paying taxes: if I have seven offices, which I visit in rotation, I want the labs for patients who live in Shoretown to go to my office in Shoretown: sending them to any of my other offices creates work and runs the risk of me not having them where and when I need them. But sending them to all my offices creates a blizzard of faxes and a mountain of filing.

Unless, of course, my practice has invested in and correctly configured a centralized, distributed Electronic Medical Record with a real-time, bidirectional Lab interface. Which, very likely, is not the case. At least not from what I see in the field. At least not yet.

So here I am, stuck in the real world, creating yet another mapping from internal LIS ordering ID (which is office-specific) to NPI (which is not office-specific but which is required by many legal agreements).

The good news is that NPI excels at figuring out which providers merit a fruit basket for all their business: I can analyze the ordering patterns by practice pretty easily by associating NPIs together into a practice. I just can't help you with where to send that fruit basket. Or those lab results.

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