This practice setting record is the source of both the UPIN
and the physician specialty available to researchers on Medicare claims.
Important for the validity of comparisons over time, the file provides the UPIN
assignment date, so that some physicians with partial-year data could be culled from the physician sample.
CMS is planning to use information from the UPIN
database to start up its new National Provider System (NPS), which will be issuing new National Provider Identifiers.
In addition, the inspector general's report found that for at least 61% of the services that were processed with a surrogate UPIN
, ordering physicians already had permanent UPINs
at the time services were provided.
were not used in all fraudulent cases, they were used on many occasions, Ms.
Most Common Inaccuracies in UPIN
Registry * Primary Specialty Certification 33% Secondary Specialty 23% Secondary Specialty Certification 18% Street Address of Practice Location 17% Zip Code of Practice Location 13% Professional School 11% State License Number 10% Group Practice Participation 9% Medicare Participation Status 7% Primary Specialty 5% Social Security Number 5% * Based on an analysis of practice records with errors.
The fear is that a physician's UPIN
could be given to someone who's out to defraud Medicare.
The probe found that from 2000 through 2007, Medicare paid for at least 478,500 claims that contained the UPINs
of deceased doctors.
The NPI is a HIPAA simplification standard that requires all physicians who submit electronic claims to payers to be identified by a 10-digit number that is replacing UPINs
and all other identifiers.
Physicians and other Medicare providers who are assigned PINs or UPINs
will need to obtain an NPI by the May deadline.