This practice setting record is the source of both the UPIN and the physician specialty available to researchers on Medicare claims.
For each distinct UPIN found in the Medicare carrier and hospital outpatient claims, we created a record in our physician-level analytic file.
If a physician was identified as a cancer specialist in the AMA Masterfile or in both the Medicare claims and UPIN Registry, he or she was considered a cancer specialist.
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.
Finally, pending further advances in UPIN reporting, the studies' results have limits on their generalizability.
The MPIES Registry then assigned a UPIN to each enumerated individual.
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.
Percentage of Practices With Inaccurate UPIN Registry Information 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% Source: Department of Health and Human Services, July 2003
The researchers found that 52% of the providers in the database had inaccurate information in at least one of their records (see chart), and 44% of UPINs have never been used, or are no longer used, to bill Medicare.
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.
Surrogate numbers should not be used if the ordering physician has a permanent UPIN, the report said.
The agency also should continue to educate physicians and suppliers that accurate UPINs be used on claims.