I had a couple conversations this week with subject matter experts from industry and government about the NPPES and PECOS systems.
|NPPES (National Plan and Provider Enumeration System) is a registry of healthcare providers, including their NPI (National Provider Identifier), specialty taxonomy and contact information.
PECOS (Medicare Provider Enrollment, Chain, and Ownership System) is a system that supports Medicare enrollment for providers and has its own similar database.
There seems to be a lot of demand for these systems to be:
- Kept up to date. Currently NPPES is often too out of date to be useful for patients. PECOS is updated more frequently, but isn’t available publicly.
- Easier to update. One of the reasons NPPES is not updated often is the difficulty and overhead of doing so. It would benefit greatly from an easier user interface, a public API and ability for surrogate 3rd parties to make updates.
- More realistic. The data model for NPPES is much to simplistic to reflect the way providers currently do their work. It should allow for many-to-many relationships between physicians, organizations and locations.
- Kept in sync. Discrepancies between NPPES and PECOS may be hard to resolve. Sometimes it’s due to NPPES being out of date. Other times it’s because the provider handles billing for Medicare differently .
First, my colleague and fellow HHS Entrepreneur-in-Residence, Alan Viars, has been leading a phenomenal effort to build a robust API for NPPES. It was created as part of HHS IDEA Lab’s NPPES Modernization Project. It’s designed to handle both efficient read access wanted by many applications and robust methods for making changes. It was developed to focus on functionality and let external developers design beautiful user interfaces.
Second, CMS’s Identity & Access (I&A) Management System may help with some of these needs. I&A is supposed to enable “streamlined access to NPPES, PECOS, and EHR” to both healthcare providers and their 3rd party surrogates. There’s an introductory presentation on the topic that explains further: http://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/508-IA-Call-FINALDM2.pdf. That said, I still need to familiarize myself with it and its capabilities.
PS: In an effort to help people who had problems with the CMS website, I uploaded a video to YouTube that demonstrates how a 3rd party can request to work on behalf of a healthcare provider as a surrogate.