Value-Base Healthcare reimbursement places emphasis on disease prevention, patient health education, and patient engagement as important components of quality care leading to decreased chronic disease and healthcare costs. Qualifying for a unique National Provider Identification (NPI) number to provide patient health education is a meaningful and important credential for qualified healthcare professionals to earn.
A credentialed and specialty trained professional who can provide comprehensive, yet demystified patient health education, better serves their patients to take control of their health and well being and also increases utilization of health insurance payment options for their patients.
Just having an NPI number, without appropriate training or credentials, does not qualify an individual to use the number, nor does it confer compliance with the appropriate and legal use of that NPI number for insurance billing purposes. Many health professionals inadvertently find themselves in difficult circumstances when attempting to bill for a service they are not properly trained in or legally qualified to use; or if they are using the credential inappropriately and are not complying with professional and legal protocol.
Nurses Please Note: For nurses, only specific APRNs can direct bill insurance carriers for reimbursement. There are NPI numbers for nurses to be used by their employer. These are not intended for a nurse to direct bill insurance coverage for reimbursement without incurring professional and/or legal consequences. Additional specialty training and credentials can lead to earning unique NPI numbers, which can be used when providing health care services. Examples: Patient Health Educator or becoming a Doula – this is a training which provides certification and qualifies for an NPI number for insurance billing.
Pursuing an accredited training, which requires licensing and educational pre-requisites is the appropriate and standard process by which one can earn this important professional credential. For more information contact NIWH at 888-354-HEAL (4325).
How to Qualify for an NPI Number
To qualify, non-physician health care professionals, such as nurses, mental health professionals, pharmacists or nutritionists, with a scope of practice that includes patient education, must earn qualifications that are consistent with guidelines or standards established or recognized by a physician society, non-physician healthcare professional society/association, or other appropriate source of training from an accredited program.
The NIWH 3-in-1 Whole Health Education® training is
accredited by the Institute for Credentialing Excellence
Value of Having an NPI Number
Comments from NIWH graduates on how qualifying for a secondary National Provider Identification or NPI number has assisted their patients and impacted their practice.
“I graduated from NIWH 6 months ago and already have a growing practice. Clients really respond to the whole person focused 5 Aspects of Whole Health™. I love to work with clients giving them the “Big Picture of Health®” and teaching them ways to prevent disease or improve their health.
“My referral partners, including physicians and mental health professionals, are thrilled that I have a National Provider Identification (NPI) number as a patient health educator, as it makes my health education services more available to their patients. Much gratitude to NIWH which has produced the best whole health and patient advocacy program in the country.”From Ann Baker, BSN, MPH – NIWH Graduate
“September 2015, I completed the NIWH Whole Health Educator program for nurses. This comprehensive program gave me the patient health education knowledge and skills I needed for a more holistic approach to my current practice. Upon completion of the program, I applied for and received my National Provider Identification (NPI) number. The NPI number has opened the door to a population of individuals who had not previously utilized my services.
“Being qualified to provide insurance billing and coded receipts has added a new level of credibility to my thriving practice. Not only does this credential validate all the hard work necessary to earn it, but in addition it provides a distinction from others in the field who do not have a NPI number to better serve their clients. It [the NIWH program] has been an incredibly rewarding experience for me both personally and professionally. A real game changer!”From Jacqui Bryan, BA, RN, MS, CHC – NIWH Graduate
“I recently completed the NIWH Whole Health Education programs for Nurses. I found the entire program engaging and motivational. I applied for and received my National Provider Identification number as a health educator. The NPI number allows for free standing clinics to partner and/or contract with me and also receive payment for my services as well as meet the requirement of meaningful use required by the Affordable Care Act.
“The NPI number also allows my personal clients to be reimbursed, either partially or fully, by their private insurances or flexible spending plans. This relieves a financial burden for my clients and increases their chances for success through additional sessions.”From Melisssa Sperry, BSN, MSN – NIWH Graduate
“After receiving my Whole Health Educator credentials through NIWH, I felt completely confident in my skills and training to begin my own pregnancy and fertility Whole Health Education practice and am concurrently working with a Reproductive Endocrinologist’s office.
“Applying for and receiving my National Provider Identification number as a Health Educator was straight-forward and now I accept Flex Spending payments and can be reimbursed for my services when I see patients through local doctors offices, making it easier for people to afford and benefit from Whole Health Education. Having an NPI number has given me credibility with doctors and clients and allowed me to open up additional doors and revenue streams.”From Heather Novak, MS in Counseling – NIWH Graduate
NIWH offers a unique opportunity for certified Nurse Coaches to earn NPI credentials for billing and coding of patient health education in private practice. For more information about this exciting opportunity visit our Nurse Coach Track page.
Questions about the National Provider Identification Number
Q. What is a National Provider Identification (NPI) number?
A. An NPI number is a 10 digit numerical identifier for providers of healthcare services. It is national in scope and unique to the provider.
Q: What is the purpose of a National Provider Identification (NPI) number?
A. The NPI number is a single identification number that is issued by the federal government to health care providers. It is intended to improve the efficiency of the health care system and help to reduce fraud and abuse.
Q: Who can receive a National Provider Identifier (NPI) number?
A. An NPI Number will be assigned to health care providers and professionals who need them to submit claims or conduct other transactions. A “health care provider” is defined as an individual, group, or organization that provides medical or other health services.
Q: Can a Health Educator have a National Insurance Provider (NPI) number?
A. Yes, appropriately trained and credentialed health educators and patient health educators are eligible to submit an application to receive an NPI number. They may also apply for and receive professional liability insurance for health education services.
Q: Can a Health Educator’s services be billed for and reimbursed?
A. Yes, there are two avenues for billing and potential reimbursement. Where applicable, and with the appropriate CPT codes, services of a health educator may be billed for and reimbursable through a medical practice, physician’s practice, nurse practitioner’s practice or other medical professional provider’s office. Patients who receive services directly from a health educator, with a National Insurance Identification number, may be able to submit the services to their employer’s Flex Spending or similar healthcare spending plan.
Q: What qualifications must the Health Educator have for billing?
A. The qualifications of the non-physician health care professionals who provide health education, and the content of the educational and training program, must be consistent with guidelines or standards established or recognized by a physician society, non-physician healthcare professional society/association, or other appropriate source.
Q: Where can I learn more about appropriate training and credentialing in patient health education for non-physician health professionals?
A. The National Institute of Whole Health has been providing professionally accredited/approved professional development programs and continuing education courses in patient health education since 1977. For more information about available post-professional patient health education training you may contact NIWH at 888-354-4325 or contact us.