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Medicare has Our Number !

Under new benefit, pharmacists may be paid for MTMS

Christine Murphy, R.Ph., Chris Green, Pharm.D., Jennifer L. Rodis, Pharm.D., The Ohio State University College of Pharmacy

The new Medicare Prescription Benefit requires medication therapy management services (MTMS) for qualifying patients. (For a general overview of this new benefit, see articles in the May 2005 and August 2005 Ohio Pharmacist journals.) Under this new benefit, pharmacists may be paid for MTMS. Pharmacists who will bill for MTM services must have a National Provider Identifier (NPI).

What is an NPI?
The National Provider Identifier (NPI) system is part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). All Medicare health care providers and health plans must have a unique identifier that is used to bill Medicare. The establishment of this new identifier system is meant to improve efficiency and the effectiveness of the electronic transmission of health information. The Centers for Medicare & Medicaid Services (CMS) developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers for all health care professionals, including pharmacists.

Why should a pharmacist get an NPI?
Since Medicare started in 1966, pharmacists have been struggling to be recognized as providers. The inclusion of pharmacists in the NPI process is one of the most important steps toward promoting pharmacists to provider status so that they can bill for cognitive services. Greg Dill, Pharm.D., a CMS Health Insurance Specialist who spoke at the OPA Annual Conference this past spring, encouraged all pharmacists to apply for an NPI. He felt that this was an opportunity for pharmacists to show Medicare that they are ready and willing to provide clinical services for Medicare beneficiaries.

How does a pharmacist apply for an NPI?
The application process is online and requires less than 30 minutes to complete. Go to Go to the section "If you are a Health Care Provider, the National Provider Identifier (NPI) is your standard unique identifier." Click on National Provider Identifier (NPI). Click on "Apply Online for an NPI." A pharmacist can apply by phone by calling: 1-800-465-3203 (NPI Toll-Free), 1-800-692-2326 (NPI TTY). You will need the following information to apply:
  • Name
  • Date of Birth
  • Country of Birth
  • State of Birth (if Country of Birth is U.S.)
  • Gender
  • Mailing Address
  • Practice Location Address and Phone Number
  • Taxonomy (Provider Type) Choose Pharmacy Service provider, then choose area of specialization, e.g., general practice, nuclear, pharmacotherapy, psychopharmacy
  • State License Information
  • Contact Person Name
  • Contact Person Phone Number and E-mail

    Within a short time, Medicare will acknowledge the online application by e-mail. At a later time, the NPI will be sent to the applicant via-e-mail.

    In June a group of OSU College of Pharmacy faculty met in the college's computer lab to sign up for their NPIs. This process took 15 to 20 minutes. For the OSU College of Pharmacy faculty, the turnaround time from online application to receipt of an NPI ranged from a few hours to about a week.

    After a pharmacist has an NPI, then what?
    When the Medicare Prescription Benefit goes into effect January 1, 2006, pharmacists with an NPI may bill Medicare for MTMS through the Prescription Drug Plans (PDPs). A pharmacist must become a provider for a Medicare Prescription Drug Plan or other third party payer before he or she can bill for services. CMS-approved Medicare Prescription Drug Plans were announced September 23, 2005. Most community pharmacy corporations are in the process of planning for how they will embark upon MTMS and deal with individual pharmacist versus pharmacy billing for cognitive services with NPI numbers. More details about the billing process will be included in a future issue of this journal.

    Since pharmacists cannot bill Medicare until at least January 1, 2006, why should they bother getting an NPI number now?
    Just as CMS pharmacist Greg Dill said, Medicare is watching to see if pharmacists take advantage of this new opportunity.

    Get a number! The OSU College of Pharmacy faculty challenges each pharmacist who reads this article to apply for his or her NPI number today. Let's show Medicare that pharmacists are glad that Medicare "has our number" and that we plan to use it!
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