Survey contends 20 percent of NPI data is inaccurate

IRVINE, CA – A recent study of standardized provider identification numbers released by the federal government questions the accuracy of the data associated with those numbers.

Some 19.7 percent of the business addresses associated with National Provider Identifiers are invalid because physicians have moved, retired or are deceased, according to a recent audit by SK&A Information Services, an Irvine, Calif.-based company that sells a product that provides telephone-verified NPI numbers. It conducted a phone survey of nearly 7,000 providers to assess the accuracy of the numbers, said Mike Green, vice president of products and research for the company.

Each provider in the country is expected to have an NPI that will serve as a unique identifier, replacing legacy provider numbers that payer organizations have assigned to providers. NPIs eventually will be required on all claims forms. Nearly 1.8 million NPIs have been issued, SK&A officials say.

Company officials say the NPI data is as much as 28 months old, because the Centers for Medicare & Medicaid Services began issued standardized NPIs in May 2005. Its research also shows that 68 percent of the NPI numbers were assigned more than eight months ago, and that the average age of an NPI is 13.2 months.

Just because NPIs are old doesn’t mean they’re inaccurate, said Michael Apfel, privacy officer at Truman Medical Center and co-chairman of the education and content workgroup for the national provider identifier outreach initiative of the Workgroup for Electronic Data Interchange.

“The vintage of the NPIs is presented with the inference of this being a problem,” he said. “An organization’s data is not very dynamic. Even if the survey was limited to individual providers, the 65 percent rate is not an alarming statistic. If anything, it is a very positive indicator of compliance with the final rule.”

“The data is presented out of context and becomes immediately suspect to those who have a working knowledge of the NPI and the legislation that created it,” he added.

Others say they aren’t surprised that inaccuracies were found. Stephen Witter, vice president of Folio Associates, says SK&A may have underestimated the percentage of inaccuracies, and he’s not convinced that data associated with NPIs will be updated as needed.

“Using the NPPES registry to maintain provider information in terms of demographics just doesn’t work because there’s no incentives for (providers) to update the data,” Witter said. “There’s nothing, from a process flow standpoint, that will force the updating of provider data.”

SK&A is continuing its study of NPI data released by the government to see if other anomolies show up, said Jack Schember, the company’s director of marketing.