UPINs, NPIs, and Other Deadlines

Internal Medicine World ReportJune 2006
Volume 0
Issue 0

Medical Officer, Office of the Administrator, Director, Physicians Regulatory Issues Team, Centers for Medicare & Medicaid Services, Department of Health and Human Services

As you know, in 1996, Congress passed HIPAA (Health Insurance Portability and Accountability Act), which includes a number of provisions important to practicing physicians and their office staff. For example, HIPAA requires that all health care claims be submitted using National Provider Identification (NPI) numbers beginning on May 23, 2007.

From UPIN to NPI

So no longer will we have a Medicaid Unique Physician Identification Number (UPIN), a Medicare UPIN, and provider numbers from each of the commercial payers. This may not seem so important to those of us who treat patients, but it is going to be a real plus for the people who generate our bills, maintain our credentials, and process the claims.

I am a reservist, and the military insisted that we get an NPI right away, so I dutifully visited the appropriate website, at https://nppes.cms.hhs.gov I completed the online application in just a few minutes, and I am now the proud owner of a shiny new NPI. In a year, I will be able to delete all the UPINs I have accumulated during 22 years of clinical practice. The new NPI is being phased into the billing process and, until May 2007, both the NPI and the "legacy" UPIN should be placed on the claim form. On May 23, 2007, the UPINs will disappear for good.

Part D Exceptions

Medicare Part D had an important deadline too. When Congress created the Part D benefit, it included a provision that imposed a penalty on those who already had Medicare but who failed to enroll in a Part D plan by May 15, 2006. Medicare participants who have prescription drug coverage from another source that is at least as good as a Part D plan (ie, creditable coverage) are not required to sign up for a Part D plan, but all other beneficiaries must sign up during their enrollment period. If they do not sign up during that period, they must wait until the next enrollment period (November 15 through December 31, 2006) and pay a penalty of 1% of the base premium for every month they were eligible but not enrolled.

A similar penalty exists in Part B for those who do not sign up when they become eligible. Insurance only works if it is purchased by an entire community; if people were allowed to sign up for auto insurance only when they had an accident, the cost of a policy would skyrocket. The same is true for Part D and Part B.

There is an exception: people who apply for and get the low-income subsidy through the Social Security Administration can sign up for a prescription drug plan after May 15. We hope that you will encourage your low-income patients to exercise this option, as it offers significant savings. In addition, people from Katrina/Rita-affected areas also have until the end of the year to sign up.

Prior Authorization

That more than 38 million Medicare beneficiaries now have prescription drug coverage is affecting physician practices more than ever. We are working to reduce, by as much as possible, the administrative burden that the benefit imposes on doctors. In particular, we are focused on unnecessary prior authorizations.

The Part B/D prior authorization problem that we discussed in this column last month should be largely a thing of the past. If prescriptions for affected drugs (those that are covered sometimes by Part B and sometimes by Part D) are written with a Part D diagnosis and the words "Part D" are on them, no other paperwork should be required.

If you are still being asked for prior authorizations to prove that a drug is being used for a Part D diagnosis, we would like to hear about it via e-mail, at PRIT@cms.hhs.gov. Please include the drug, diagnosis, state, date, and plan.

IOM Report Underscores Burden of Sleep Disorders in America

By Rebekah McCallister

A new report released by the Institute of Medicine (IOM), "Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem," highlights the extent of sleep problems in this country and sheds light on the unrecognized and underdiagnosed sleep disorders that are deteriorating the health and daily performance of large numbers of Americans.

The IOM report provides strong documentary evidence that disrupted sleep not only results in significant deleterious health consequences, such as hypertension, cardiovascular disease, diabetes, and depression, but also impairs work and driving performance as well as learning and memory.


Michael H. Silber, MD, MB, ChB, professor of medicine, Mayo Clinic, Rochester, Minn, and incoming president of the American Academy of Sleep Medicine (AASM), which sponsored the report, told , "The IOM report highlights the extremely serious consequences of insufficient sleep. Increasing research suggests that voluntary sleep deprivation has physical, as well as psychological, consequences, including obesity, impaired glucose tolerance, and depression."

The new report calls for additional investment by different health care bodies to address this issue. The report outlines the steps that are needed to remedy the current situation, including:

? Recognizing that sleep disorders and sleep deprivation are significant public health problems that have a wide range of deleterious health and safety consequences

? Developing a multimedia educational program to foster increased awareness among the general public and health care professionals about the physiology of healthy sleep across the lifespan, and of the importance of sleep to health, performance, learning, and safety

? Instituting programs to promote the early diagnosis and treatment of sleep disorders

? Improving surveillance and monitoring by the Centers for Disease Control and Prevention of sleep patterns in the US population and of the public health burden of sleep loss and sleep disorders

? Recognizing that sleep medicine is an independent field that is interdisciplinary in nature but requires special training

? Increasing the number of trained scientists in other disciplines who focus on sleep-related research and integrating the teaching of sleep science and sleep medicine into undergraduate, graduate, and professional education programs

? Training more research scientists in the fields of sleep science and sleep medicine and training more clinicians in the field of sleep medicine.

This report is the latest in a series of developments highlighting the need for greater attention to lack of sleep and sleep disorders among Americans.

Dr Silber emphasized that "sleep disorders are extremely common, but unfortunately most medical schools and residency programs devote little time to their study. Primary care physicians are at the interface between patients and the health care system and thus have a major role in identifying disorders of sleep and wakefulness. The increased detection and treatment of obstructive sleep apnea, restless legs syndrome, insomnia, and other disorders is crucial."

The American Board of Medical Specialties has only recently recognized sleep medicine as a subspecialty. On July 1, 2006, physicians for the first time will be able to be trained as sleep specialists in newly accredited programs nationwide.

Dr Silber concluded that "the IOM report is a strong call for primary care physicians to learn more about the recognition of these disorders, their primary level management, and the availability of board-certified sleep specialists in accredited sleep centers." Dr Silber added that many continuing medical education opportunities are available in sleep medicine, not only those offered by the AASM.

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