November 1, 2013 Departments

Bottom Line: School Clinicians Need National Provider Identifier for Medicaid

Audiologists and speech-language pathologists providing services to Medicaid-eligible students need to apply for and use the NPI for documentation and billing.

Bottom line

Under a new federal rule, school-based audiologists and speech-language pathologists must have a National Provider Identifier number or other unique identifier to provide services to Medicaid-eligible students in 2014.

Obtaining an NPI, already required for clinicians in health settings, is a relatively easy process. Here's what you need to know.

What is an NPI?

The NPI is a unique 10-digit identification number required of all covered health care providers under the Health Insurance Portability and Accountability Act. Providers, health plans and certain other organizations use their NPIs—which replace any previous provider identification systems—in a variety of administrative and billing transactions. NPIs will or may be required to complete a Medicaid claim, depending on the individual state requirements.

Who needs an NPI?

School-based audiologists and SLPs must have an NPI number or an acceptable alternative (a "unique identifier number") to complete a Medicaid claim. Each individual state Medicaid plan decides who will need an NPI. If the state requires NPI for school Medicaid billing, the school district may require each audiologist or SLP to obtain an NPI. District policies may dictate whether or not an NPI number will be required.

How do I apply for an NPI? Is there a fee?

Audiologists and SLPs can apply online or call 800-465-3203 to request an application. The process to apply for and receive an NPI is simple, free and takes only a few minutes. Check with your school district to determine if you should apply individually or if the district plans to collect information and apply on behalf of all its providers.

What is the application deadline?

The actual implementation date is different from state to state. Many states will require school-based providers to obtain an NPI in 2014.

Will this process affect my income tax obligation?

The answer depends on whether a clinician is an employee of a district or an independent contractor. If a clinician is employed by a school district that contracts directly with the health care agency (Medicaid), the individual clinician's income taxes are not affected, even though the provider's NPI may be listed on claims as the "rendering provider."

If, however, the audiologist or SLP is an independent contractor billing Medicaid directly for services provided in the school setting, reimbursement for those services is considered taxable income.

Where can I find more information?

ASHA, the federal government and other organizations have several resources on NPI:

For more information on NPI or other funding issues related to school-based practice, contact Kathy Wheat, chair of the ASHA School Finance Committee, kathy.j.wheat@occc.edu.

Janet Deppe, MS, CCC-SLP, is ASHA director of state advocacy. jdeppe@asha.org

cite as: Deppe, J. (2013, November 01). Bottom Line: School Clinicians Need National Provider Identifier for Medicaid. The ASHA Leader.

  

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