Do You Need an NPI Number?

Author: James C. McAllister III, MS, FASHP
Pharmacy Times Editor, Health-Systems Pharmacy Section

In his April 2007 Editor’s Note (viewable at www.pharmacytimes.com), Fred Eckel urges payers to restructure financial incentives for pharmacies. He suggests that a shift from the traditional dispensing-based approach would enable pharmacists to focus their energies on activities that result in drug misadventures and optimizing therapeutic outcomes. I suspect that overall health care costs would be reduced as well, as evidenced by initiatives such as the Asheville Project. Mr. Eckel refers to the emerging medication management programs as a glimpse into our possible future and concludes that such activities should lead to a more secure professional future, thus increasing our value to the people we serve.

The majority of our readers are aware of the National Provider Identifier (NPI) number issue. The NPI concept was part of the Health Insurance Portability and Accountability Act legislation enacted in 1996 and is intended to establish electronic data exchange, establish unique identifiers for individuals and corporate providers, and protect security and privacy of patient information. The mostexciting dimension of the NPI legislation is that pharmacists are specifically identified as potential providers who are authorized to apply for an NPI number.

NPI numbers are, or will be, essential for any pharmacist who is eligible to submit a bill for cognitive services. It will be essential for all pharmacy practitioners who perform medication therapy management services, as well as related activities in medication management, but it does not broaden the scope for what pharmacists can bill. For pharmacists who practice in health systems, only those who practice in ambulatory care settings will need an NPI number initially.

So, why should you apply for an NPI number? I believe that, if a large number of pharmacists apply for a number, a signal will be sent that we as a profession believe we have more to offer than traditional roles recognized by the lay public. It also prepares us for the possibility that, like our colleagues who practice in an ambulatory setting, health system pharmacists have the skills and interests to provide valuable (and time-consuming) services that improve drug therapy outcomes. Many practitioners already have practices that are more patient-focused and only loosely affiliated with the dispensing activities for which hospitals bill. We must continue to be able to bill for the essential and equally important drug distribution and control functions on which our profession is based. Hospitals are being held accountable by the Centers for Medicare & Medicaid Services for certain core measures such as smoking-cessation initiatives, vaccination programs, post–myocardial infarction therapy, and much more. Such activities are a perfect fit for our training and interests. It seems inevitable that we will be compensated for acute care drug therapy management activities. If such an opportunity knocks, those of us who have NPI numbers can begin billing without looking for a vehicle to do so.

As I have told my staff, application is easy and free, and you receive your number in a timely fashion. To learn more about the NPI issue, I suggest that you visit the Web site of the National Plan and Provider Enumeration System, https://nppes.cms.hhs.gov. If you want to apply for your own NPI number, go to https://nppes.cms.hhs.gov/NPPES/Static Forward.do?forward=static.npistart. It could be a part of an exciting journey. (P)T

Mr. McAllister is director of pharmacy at University of North Carolina (UNC) Hospitals and Clinics and associate dean for clinical affairs at UNC School of Pharmacy, Chapel Hill.