American Academy of Professional Coders (AAPC) Practice Exam

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Who is typically required to use an NPI?

  1. Patients seeking healthcare

  2. Healthcare providers conducting transactions

  3. Insurance company claim adjusters

  4. Healthcare technicians managing records

The correct answer is: Healthcare providers conducting transactions

Healthcare providers conducting transactions are typically required to use a National Provider Identifier (NPI). The NPI is a unique identification number assigned to healthcare providers in the United States, which is essential for billing and electronic healthcare transactions. The use of the NPI is mandated by the Health Insurance Portability and Accountability Act (HIPAA) for covered healthcare providers when they submit health care claims and conduct other transactions like eligibility inquiries or claims status inquiries. The purpose of the NPI is to simplify and standardize the identification of healthcare providers across the healthcare system, which enhances efficiency and accuracy in billing and administrative processes. Other groups mentioned, such as patients, insurance claims adjusters, and healthcare technicians, do not typically have a requirement to use an NPI for their transactions or duties, thus highlighting the specific role of NPIs among healthcare providers.

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