Author Topic: Adding NP!!!  (Read 3718 times)

Misil

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Adding NP!!!
« on: February 07, 2014, 10:27:24 PM »
Hello,
There's a doctor who wants to add NP under group provider numbers.
The NP is new and not credentialed with any insurance companies.

Questions are:
1. How do I add this NP under a doctor's group medicare number & commercial insurance provider numbers in order to bill?
 
2. After adding this NP under a group id numbers, how do I fill out the CMS 1500 form?
    (In this case, NP will be working and will be billed under group provider numbers.)

3. After adding this NP under group in numbers, can this NP also provide ob/gyn procedures and bill?

Thank you.

RichardP

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Re: Adding NP!!!
« Reply #1 on: February 08, 2014, 12:13:43 AM »
There's a doctor who wants to add NP under group provider numbers.

I assume that you are saying there is a Doctor's Group (that meets the legal CMS definition of "Group"), with a Group NPI Number, that wants to hire an NP.  If, instead, there is a doctor in the group who wants to hire the NP to work personally for him, let us know that.

Read through all five of these links.  Each comes at the NPI number from a slightly different perspective.  Come back with any remaining questions.

http://www.medicalbillinglive.com/members/index.php?topic=7045.msg21031#msg21031
http://www.medicalbillinglive.com/members/index.php?topic=7272.msg22414#msg22414
http://www.medicalbillinglive.com/members/index.php?topic=7436.msg23215#msg23215
http://www.medicalbillinglive.com/members/index.php?topic=7299.msg22542#msg22542
http://www.medicalbillinglive.com/members/index.php?topic=7418.msg23109#msg23109

This link may or may not be relevant if the NP is bringing patients with them to the new organization.

http://www.medicalbillinglive.com/members/index.php?topic=7343.msg22913#msg22913

Misil

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Re: Adding NP!!!
« Reply #2 on: February 08, 2014, 11:57:32 AM »
Yes, there's a doctor's group with a group npi number, that wants to hire a NP to work under him/her.

1. For Medicare, do I have to fill out 855R?

For commercial insurances,
1. what if the doctor has individual provider numbers instead of group provider numbers?
2. Do I have to apply for group provider numbers, then add the np under that group provider numbers?
3. Does the np have to use group npi or his/her individual npi #?

Thank you RichardP for the info.

RichardP

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Re: Adding NP!!!
« Reply #3 on: February 08, 2014, 03:50:16 PM »
... there's a doctor's group with a group npi number, that wants to hire a NP to work under him/her.

From one of the links I provided above:

A collection of service providers may come together and form an organization that is a legal entity.  That legal entity must then obtain a Type 2 NPI Number (who gets paid).  All billing would be done in the name of the legal entity, using that legal entity's Type 2 NPI Number.  All payments would be made to the legal entity, and the legal entity would then pay its owners and employees according to a written payment schedule.  In this situation, some insurance carriers (including Medicare) require that the Type 1 NPI Number (who did the work) of the service provider who actually did the work be included when billing.

An organization does not and cannot provide services to a patient (that would be done by a human).  Neither can an organization have a gender.  You say you have a Group, and the Group has it's own Type 2 NPI Number (who gets paid), and then you end your statement by referring to the group as a "him or her".

So - one more time so that our answers might address your actual situation:  are you talking about a legally-created Group, with its own Type 2 NPI Number (who gets paid), that wants to hire a NP, and will pay the NP?  Or are you talking about a real, live person who belongs to that Group that wants to hire the NP, and will pay the NP?

Misil

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Re: Adding NP!!!
« Reply #4 on: February 08, 2014, 06:14:23 PM »
A real, live person owns the group PC, and wants to hire the NP to work under him.
Then, the NP will be provide service(s), and will be billed using that live person's group provider number, then will pay the NP.
(Hope this clarify your confusion.)
« Last Edit: February 08, 2014, 06:23:05 PM by Misil »

RichardP

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Re: Adding NP!!!
« Reply #5 on: February 09, 2014, 01:56:06 AM »
A real, live person owns the group PC, and wants to hire the NP to work under him.

Yes.  Real, live people usually are the ones who own Groups.  But Groups (properly formed) are legal entities that can conduct business in their own name.  A (properly formed) Medical Group must be the billing entity and must have its own Type 2 NPI Number (who gets paid).  So:

1.  Who is doing the hiring?  The Group (a legal entity) or the real live person?

2.  Who will bill for the NP's work?  The Group (a legal entity), using their Type 2 NPI Number, or the real live person, using his Type 2 NPI Number?

3.  Who will pay the NP?  The Group (a legal entity), or the real live person?

The answers you seek depend upon a correct answer to these three questions.  Every time you answer, you throw in something that makes your answer unclear.

... can this NP also provide ob/gyn procedures and bill?

The NP can be paid for providing OB/GYN procedures only if his Taxonomy Number allows him to.  And if the NP is hired by the Group, he cannot bill for his own services.  The Group is the billing entity, so it will bill for the NP's services and pay him a salary.
« Last Edit: February 09, 2014, 02:03:06 AM by RichardP »

PMRNC

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Re: Adding NP!!!
« Reply #6 on: February 09, 2014, 02:05:50 PM »
Quote
Yes.  Real, live people usually are the ones who own Groups.

LMAO... what about the Zombies?
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Michele

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Re: Adding NP!!!
« Reply #7 on: February 10, 2014, 07:37:27 AM »
Misil,

I don't like to assume but for sanity's sake I'm going to assume the following:

There is a doctor (live) that owns a group that wants to hire an NP to work in the group.  The group would get the payments.

Assuming the above statement to be describing your situation here are some answers to your questions:

Yes, there's a doctor's group with a group npi number, that wants to hire a NP to work under him/her.

1. For Medicare, do I have to fill out 855R?

You would not only have to fill out the 855R but since the NP is new and is not credentialed with any insurance carriers you also need to complete the CMS 855I.

For commercial insurances,
1. what if the doctor has individual provider numbers instead of group provider numbers?

If the doctor wants to have the NP work under the group, then the group should be established with ALL insurance carriers.  If the group is only established with some and the dr bills individually under others that is going to be a billing nightmare.  But I guess technically the NP could be set up under the dr with those companies.  Personally I would not do it that way and I would tell the dr why. 

2. Do I have to apply for group provider numbers, then add the np under that group provider numbers?

You have to contact each insurance carrier to see what they require to add the NP.

3. Does the np have to use group npi or his/her individual npi #?

The NP would use his/her individual NPI as the rendering provider on any services performed by them.



I hope this helps.  Your information was rather confusing. 
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Misil

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Re: Adding NP!!!
« Reply #8 on: February 10, 2014, 11:58:43 AM »
Michele, yes, your assumption is right.

There is a doctor (live) that owns a group that wants to hire an NP to work in the group.  The group would get the payments, then will pay the NP.
You said, You would not only have to fill out the 855R but since the NP is new and is not credentialed with any insurance carriers you also need to complete the CMS 855I.""

Does the NP have to complete 855I even though the claims will be billed using group ID #?


RichardP

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Re: Adding NP!!!
« Reply #9 on: February 10, 2014, 02:05:18 PM »
There is a doctor (live) that owns a group that wants to hire an NP to work in the group.  The group would get the payments, then will pay the NP.

For a Group to meet the CMS definition of "Group", and therefore be considered legal for billing purposes, it must meet at least the following requirements:

1.  Be an actual Group.  That is, it is owned by more than one physician.

2.  Be a legally-constituted entity, with its own Taxpayer ID Number and Type 2 NPI Number and designated officers who conduct business in the name of the Group.

3.  Reimbursement criteria must be laid out in writing and a copy submitted to CMS.  Reimbursement must be based on pre-defined criteria.  No one can be paid based on their productivity (e.g., the more patients you see, the higher your pay).

I researched this extensively about 6 years ago and have copious notes and print-outs from CMS somewhere.  I can't take the time to find them at the moment, so I'm operating from memory.

I don't remember that a single practitioner can be the sole owner of a "Group".  But I am willing to be corrected if the truth is different.

The reason I'm making an issue of this is because, if this is actually a single practitioner, rather than a legitimate Group, the practitioner has the option of the NP billing in the name of the practioner - which will generate a higher reimbursement and the NP does not need to have an NPI Number (the supervising physician's Type 1 NPI Number would go in Box 24J for Medicare work).  The NP would also not need an OB/Gyn Taxonomy number if the supervising physician had one.  If working for a practitioner, the NP can also bill in their own name, but for that they would need their own NPI Number, OB/Byn Taxonomy number, and the reimbursement rate is lower.

http://www.apapracticecentral.org/news/2008/group-practice.pdf
« Last Edit: February 10, 2014, 02:07:56 PM by RichardP »

PMRNC

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Re: Adding NP!!!
« Reply #10 on: February 10, 2014, 02:25:05 PM »
I guess we are still not acknowledging the difference between a LIVE provider and NON live provider? LOL
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Merry

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Re: Adding NP!!!
« Reply #11 on: February 10, 2014, 09:00:46 PM »
<<I don't remember that a single practitioner can be the sole owner of a "Group".  But I am willing to be corrected if the truth is different.>>

Yes, I see it all of the time..but you must be sure to put a rendering provider down with the individual NPI in box 24K. And the group NPI in the practice information.

Michele

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Re: Adding NP!!!
« Reply #12 on: February 11, 2014, 08:39:07 AM »
I am not sure of the legal aspect of what constitutes a group but I know that one practitioner can form a corporation.  I am certainly not a legal expert.  Richard made some good points about reimbursement that should be considered when the provider makes the decision on how they want to set this up.
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RichardP

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Re: Adding NP!!!
« Reply #13 on: February 11, 2014, 01:47:13 PM »
I guess we are still not acknowledging the difference between a LIVE provider and NON live provider? LOL

I know it sounded funny, but it is a serious distinction between a live person and a legal entity - as both can conduct business in their own name, but the legal requirements imposed on each are different.  Plus, the recent U.S. Supreme Court ruling that corporations are "persons" for the purpose of free speech.  Both a "live" person and a "corporate" person can own a business.  Given the difference in legal requirements imposed on each "person", it is important to know which one you are talking about.