January 29, 2012

Practice Group Data Now Part of CP ListMaker

Jan. 29, 2012 -- CarePrecise announces a major upgrade of its  CP ListMaker software that puts all 3.5 million U.S. healthcare provider records – including almost one million physicians – in reach for marketers. Now includes practice group data to help qualify sales leads.

Today we announced a new version of our popular CP ListMaker software, our desktop system that puts all of the 3.5 million healthcare provider records – including approximately one million physicians and tens of thousands of hospitals and ambulatory care facilities – at the fingertips of researchers and marketers. CP ListMaker allows users to pull tightly targeted lists of physicians and other providers based on criteria such as specialty, subspecialty, facility types for organizations, provider gender, wealth/poverty of service area, Medicare enrollment, and many more. The new version, CP ListMaker 3.5, unveils new practice group data, and does it in an interesting way.

Until now, it has been difficult to find data indicating provider’s practice groups. With new data now obtained from Centers for Medicare and Medicaid Services (CMS), combined with CarePrecise’s advanced record linkage system, CP ListMaker identifies practice groups, and can list all of the providers working at each practice location. 

The “Co-location codes” attached to each record make it possible to further qualify potential prospects for companies marketing to the medical community. Not only physician practices, but dental groups, behavioral services groups, and all other HIPAA-covered healthcare providers are co-location coded. The new CP ListMaker offers tools for using the new data. For example, to export a list of obstetric/gynecology group practices of between 3 and 20 members.

CarePrecise’s record correlation processes also make it possible to link providers’ PECOS and LEIE records with their NPI (National Provider Identifier) records ( http://www.careprecise.com/pecos-npi ), providing a rich master record ( http://www.careprecise.com/provider-data-linkage.htm ) that can be used to enrich or update customers’ existing databases. The PECOS data (indicating which providers are enrolled to be able to bill Medicare) has recently been redacted by CMS, now providing only a partial NPI number; however, our system restores the full NPI number. The federal List of Excluded Individuals/Entities (LEIE) database, which lists providers who have been barred from billing federal programs due to fraud convictions or other infractions, also has no unique identifier as distributed; however, CarePrecise links the LEIE data to the NPI data with each monthly update.

With or without a unique identifier, such as an NPI, EIN, UPIN or OSCAR -- or even a telephone number -- the CarePrecise master data management system, known as QoRelate® (http://www.careprecise.com/provider-data-linkage.htm ), can pull provider data together into a master record database from diverse sources. The company offers boutique record linkage services that can be used to merge data acquired during mergers and acquisitions, through cooperatives such as Health Information Exchanges, or from multiple in-house systems.

CP ListMaker is available as part of the CarePrecise Gold bundle, which includes CP ListMaker and the full U.S. healthcare provider database, or separately for customers who already subscribe to the CarePrecise data. The tool runs in Microsoft Access 2003, 2007 and 2010, and is provided open source, making all of the Access tools available to users.

CP ListMaker healthcare provider research and market targeting tools:
QoRelateMaster Data Management & Record-Linkage:

CarePrecise Gold (complete U.S. healthcare provider database with marketing and research tools):

January 7, 2012

Sorting Out Practice Group Data

Starting with the November 2011 distribution, CMS began including 15 new fields in the NPPES database related to practice groups. These are actually taxonomy codes; the taxonomy code set includes two group codes: 193200000X Multi-Specialty Group and 193400000X Single Specialty Group. The definition of the single specialty code is "A business group of one or more individual practitioners, all of who [sic] practice with the same area of specialization." That should clear it all up, right? Oh, no.

So these are not necessarily physician groups. That's fine, but additional questions remain, like Why aren't these taxonomy codes reported in the taxonomy codes section of the NPPES? The documentation from CMS is mum. And why is it that individual (Type 1) practitioners can call themselves a "group" when the NPI regulation says that a Type 1 provider is a single human being ? There are more than 1,000 of these in the data. So, a group can be physicians or not, or a mix, and a group can be one guy. And these two taxonomy codes aren't in the providers' taxonomy code data. Oh, and providers can report these same two codes up to 15 times (presumably having some relation to the up to 15 taxonomy codes in that other section of the data?) And, given 15 fields to play with, they can report being both a single specialty group and a multi-specialty group.


And there just happens to be many more group practices out there than are reported via these codes.

Using the new group codes data to actually identify groups, then, is somewhat less than doable. So we've taken a different tack.

Many of our clients need to know the group status of an individual practitioner. Let's take some really common examples. Let's say you are putting together a clinical trial for a new drug, or a marketing campaign for a new device. By phone, fax, and/or mail, you plan to contact a few thousand physicians in this state, a few thousand in that state, etc. You don't want to deluge a practice with 50 letters or phone calls all at once (and some practice locations are that big and bigger), so you need to know the practice group for the physicians on your list, so you can stagger your communications. Or, let's say, you just want to reach the CEO or medical director for a given group. Well, as it happens, the CEOs isn't always the record that indicates a group practice; it's sometimes the office manager, credentialing coordinator, or just a young doc who can pilot the laptop. How do you sort all this out? Well, frankly, you couldn't, until now.

Beginning this month the CarePrecise Access dataset contains a new feature called a "CoLoCode" (co-location code). The CoLoCode is derived from deeply conformed practice location data, and each provider record gets one. Look up a group (using the CMS Group codes or by looking for a number of physicians co-located at the same practice address), then plunk that CoLoCode into a query to show you all the providers practicing at that location. Voila!

To make it even easier, we are releasing a new version of our CP ListMaker software, with new group features that take full advantage of the CoLoCodes and new CMS group data.

CMS Redacts NPI in PECOS File: Solution

The PECOS Ordering and Referring Report has been a tremendous resource for those of us who have to know whether a business partner is eligible to bill Medicare. A great example is the DME supplier who needs to know that the physician who orders a patient's medical equipment is authorized to do that; could cost him money when the claim is rejected. Well, that report has just gotten a mite less useful.

(UPDATE: Here's a press release we just sent on this issue, and a page on our website with details.)

Starting with the current release, CMS has blocked out the first 6 digits of the NPI number. It looks like ******1234. Utterly useless if you want to incorporate that file into your business systems. We have a solution!

CarePrecise specializes in healthcare record linkage projects. We collect data files from many sources and, using our QoRelate record "linking and shrinking" system, match them into our NPI database. The PECOS Ordering and Referring Report and the pending enrollment files are no exception. Our system can still tell you which providers are enrolled to bill Medicare or have a pending enrollment -- with their NPI number and a lot of additional information the PECOS reports never offered.

In fact, we not only match up NPI numbers with PECOS enrollment, we also do it with the federal List of Excluded Providers (LEIE), the now deprecated but still useful UPIN registry, state license numbers, phone and fax numbers, both mailing and practice addresses, economic data from the US Dept of Commerce, and much more. Now we can even tell you how many providers practice at the same location, and give you the providers who report as a multi-specialty or single specialty practice group.

It's all in CarePrecise Gold (and everything except the economic data is in our basic dataset, CarePrecise Access), for 3.5 U.S. healthcare million providers.