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Issue Date: June 2005

A Designation Both Standard and Unique
With little fanfare, another facet of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) went into effect on May 23, 2005. On that day, the National Provider Identifier (NPI) became the official “standard unique health identifier” to be used by health care providers when submitting electronic claims to insurers or conducting other transactions covered by HIPAA. The NPI contains nine numbers that refer to the individual practitioner and a 10th “check digit,” which makes it possible to use a simple mathematical formula to verify the series’ authenticity. In some circumstances, the NPI will be preceded by the prefix “80840”; “80” specifies health applications; “840” denotes the United States.

Billing for an Ounce of Prevention
Since January 1, 2005, newly enrolled Medicare beneficiaries have been entitled to what is described as a “once-in-a-lifetime” benefit: an initial preventive physical examination (IPPE). Also known as the “Welcome to Medicare Physical,” the IPPE is one of three new preventive benefits put in place by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Screenings for cardiovascular disease and diabetes have been added to the Part B benefits package as well. These extras underscore Medicare's intent to turn more attention to disease prevention and management.