It is crucial to have a proper credentialing system for every healthcare organization. These credentials maintain the integrity of an organization and make it reimbursed by other insurance companies and higher health authorities. The main two identities in this field are NPI and medical license number. Both are different from each other in the sense of purpose, issuance, and procedures.

In this blog post, we will mainly focus on NPI vs. License number. We will delve into their purposes, types, and importance. Further, we will talk about a professional medical billing company and will see how they are efficient in providing credentialing services.

NPI vs. License Number: Comparison

First of all, you should know about the basics of these terms. You should have a clear understanding of what they are.

What is NPI?

NPI stands for National Provider Identifier. It is a 10-digit specific code that is assigned by the Centers for Medicare & Medicaid Services (CMS) to all healthcare organizations. There is no need for a hospital’s specific ID, if hospitals have this number.

It is recognized nationally and simplifies the administrative process effectively. It is also associated with HIPAA-based electronic transactions that give surety of your compliance. Thus, it establishes a single standard for provider identification across the country.

What is Medical License Number?

The medical License number is a credential that is assigned by a state medical board to all healthcare providers. This number is allotted when the person is fulfilling all the conditions of practice in the medical field. It indicates that the doctor or other staff person gives the surety of fulfilling educational, training, and ethical standards.

In NPS vs. License number, the latter is assigned after passing the licensing exam. Medical licenses are specific for every country or state. Thus, it shows that if a person wants to practice in more than one state, they will pass separate licensing exams and will get separate numbers.

Difference between NPI and license number:

There is a vast difference between NPI and license number. Let us dive into it.

Purposes:

The purposes both numbers are different such as:

NPI:

• It streamlines the administrative work of a hospital.
• It is also helpful in the successful submission of claims and for Electronic Health Records (EHR)
• Every hospital has a specific NPI. Thus, it is valuable in identifying a hospital from a large number of healthcare systems.

Medical License Number:

• It reduces malpractice and quack practices.
• This number makes sure that providers have passed all the required exams and criteria to practice in the state.
• It provides legal permission to practice in a designated state.
• People can trust practitioners because they know that they are stuck to state-specific practice standards.

Issuing Authority:

The issuing authority of NPI is the Centers for Medicare & Medicaid Services (CMS). However, the issuing authority of the License number is the State Medical Board

Scope:

In the NPI vs. License number, it is important to know about where both are implemented. NPI is national, which means that it is implemented for the whole country. But the other one is specific, it means that it is unique from person to person.

Format:

The format of NPI is constant and has 10 digits for all. The format of the license number is different from it. It is varied and is distinct for every state.

Renewal Requirements:

Usually, NPI does not need to be renewed because higher medical authorities assign it. It is renewed only when there are updates for the whole credentialing system.

Meanwhile, the license number is renewed regularly. Usually, doctors or physicians have to renew their licenses after many years and then this number is changed. Renewal requirements of this number also depend upon the state regulations.

Importance of healthcare provider credentials:

Although there are many differences between NPI and license numbers, their significance is almost the same in hospitals’ credentialing processes.

Patient Safety:

In healthcare setups, patient safety is a priority. The main purpose of checking healthcare provider credentials is to ensure the safety of patients. Medical license numbers confirm that healthcare providers are eligible to do medical practice and any malpractice can cancel their license.

On the other hand, NPI ensures the safety of patients in such a way that they are going to the right hospitals. Any hospital that could not get its NPI number or number is canceled due to any reason and patients are discouraged from going for their treatments.

Reduce Frauds:

These credentials are also helpful in reducing fraud in hospitals. NPI with its specificity increases the transparency in billing and coding tasks. Hospitals will be clear in submitting claims and doing other administrative tasks with the fear of their NPI number being canceled.

On the other hand, medical license numbers decrease the fraud of uneducated practiceoner. It makes sure that only the right, educated, and compliant doctor will treat the patients. Thus, it reduces frauds like malpractice and fake treatments.

Successful Claim Submissions:

In NPI vs. License number, both play their major roles in stabilizing the financial health of a healthcare organization. Many insurance companies and payers of the patients need the NPI number of the hospital. If the hospital provides this number on time, claims will be submitted quickly and successfully. Thus, payers pay the payment on time without any delay.

On the other hand, many companies also want the license number of the doctor by which the patient is treated. It is also helpful in successful claim submissions and in improving financial stability of the organizations.

Improve healthcare reimbursement process:

Every hospital wants an efficient and smooth reimbursement. It is possible when the hospital is verified by insurance and payer companies. These credentials like NPI and medical license numbers help verify the hospitals.

Companies can verify these credentials automatically. It reduces delays and discrepancies that might otherwise hold up payments due to incomplete or inaccurate provider information.

Accountability and Traceability:

NPI can be used by healthcare facilities for monitoring treatment histories, healthcare provider contacts, and clinical results. This system of traceability improves the likelihood of patient care. This system also tells how medical staff offer services responsibly and ethically in conjunction with having documented records of their contribution towards patient care.

On the other hand, medical license number also shows the accountability in healthcare providers. With this number, a state’s healthcare authorities can ask the staff for their malpractice if any related issue rises. This accountability not only protects patients but also helps authorities that aim to enhance the quality of patient care institutions.

Types of National Provider Identifiers:

In the difference between NPI and license, one thing to note is that NPI has different types, but license number does not. There are two different types of NPIs:

Type 1:

It is also called individual NPI. As the name shows it is assigned to the individuals of healthcare organizations. Individual NPI number is assigned to the doctors, nurses, medical lab technologists, and therapists. Although it is different for all individuals.

Type 2:

It is also called Organizational NPI. As the name indicated it is allotted to all healthcare setups including hospitals, clinics, and group practices. Organizational NPI is used by these healthcare organizations to identify themselves as transparent billing entities in transactions.

A short overview of NPI vs. License Number:

The information on the medical license number confirms the permission to practice in one or more states of the country, and the NPI serves as a national number that facilitates healthcare billing and coding transparently and without compromising on compliance. Both of these identifiers aid a healthcare provider’s capacity to work effectively while avoiding legal infractions at both the state and federal levels.

Both help maintain the integrity and financial health of a hospital. Both work differently and give different advantages, but hospitals need both credentials to work smoothly.

Also Read: AI in Radiology: Balancing Efficiency, Ethics, and Compliance in RCM

SysMD Credentialing services:

Do you feel the credential system is complex and difficult to understand? Do not worry SysMD; a professional company that will streamline this system for you. We at Sysmd  provide a wide range of medical credentialing services to our clients.

We assist organizations in obtaining such details as NPIs and medical licenses. With SysMD, you can decrease the extra load of paperwork, spend more time on patients, and keep abreast of your credentials at all times. We also make sure that your practice is not interrupted and increase reimbursement’s effectiveness for your hospital.

Conclusion:

In conclusion, NPI vs. License number, both are crucial credentials for every hospital. They support regulatory compliance, patient safety, and operational efficiency. While NPIs simplify administrative tasks and promote transparency, medical licenses validate a provider’s right to practice legally within specific jurisdictions. Together, these credentials form the foundation for a compliant and efficient healthcare system, benefiting providers, patients, and administrators at the same time.

To seek assistance in complex credentialing services, you can connect with SysMD. It is a highly efficient and professional billing transaction company that will improve the financial health of your system by submitting claims and improving reimbursement.