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1991.09.06 :  Medicare Physician Identifiers

Contact:  Bob Hardy (202) 245-6145
September 6, 1991

        Gail R. Wilensky, Ph.D., administrator, Health Care
Financing Administration, announced today the publication of a
directory which contains a unique identification number for each
of the 583,000 physicians and limited license practitioners who
serve Medicare beneficiaries.
        Publication of the Unique Physician Identification Number
(UPIN) Directory is required by the Omnibus Budget Reconciliation
Act of 1990.  The UPINs are assigned to medical doctors,
osteopathic physicians, dentists, optometrists, podiatrists and
chiropractors.
        All providers of referred and ordered services, including
physicians and suppliers, are required to indicate on Medicare
claim forms the UPINs for the ordering or referring physicians as
of Sept. 1.
        Medicare contractors will use the UPINs in processing
claims for services to identify physicians who order services for
Medicare patients or refer their Medicare patients for services. 
Medicare contractors are insurance companies under contract with
the Health Care Financing Administration to process and pay
claims.
        The Omnibus Budget Reconciliation Act of 1989 prohibits,
with certain exceptions, a physician from referring a Medicare
beneficiary to a clinical laboratory in which the physician or 
immediate family member of the physician has a financial interest
arrangement. 
        The UPINs will be used to identify such situations and
provide a means to review the referrals or ordering of services 
and the volumes of services provided.  
        Wilensky said, "This is the first time Medicare has
developed a national file of unique identification numbers for
physicians.  It will be an important tool for identifying
patterns of medical practice by individual physicians."
        Medicare carriers are providing the directory free of
charge to each physician or other health care provider or
supplier upon request.
        The national directory is published in 22 volumes, each
representing a geographical area.  The data in the directory
includes each physician's name, credentials, UPIN, state, ZIP
code, carrier assigned number and specialty code.
        The Government Printing Office is making the UPIN
directories available for sale to the public.  The national
directory will also be sold in the form of electronic media. 
Orders for the electronic version may be placed with the GPO at
202-275-0186.  Printed directories may be ordered by calling 202-
783-3238.


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