Author Topic: Group or Individual NPI  (Read 15263 times)

jcbilling

  • Full Member
  • ***
  • Posts: 156
Group or Individual NPI
« on: September 13, 2008, 02:57:34 PM »
Hello everyone!

First, I wanted to tell Alice & Michele how much I appreciate this forum and their resourceful website. It is very encouraging to me to have it available.

Secondly, I recently signed a contract with 4 doctors - three are chiropractors and one is a family practitioner. There are three locations, with the main chiropractor and family practitioner practicing in the same office and the other two chiropractors have two separate locations. The main chiropractor asked if they need to bill under a group NPI or individual NPI. Right now, all the family practitioner's claims are under his NPI, but they practice in the same building. He recently left the local hospital to practice with the chiropractor.  All four of the providers have individual NPI's, but one currently bills under the main chiro's NPI - which I told him I didn't think was right - he agreed.

Now that I have everyone confused, myself included :) how do I find out how it ought to be done - group or individual?

Also, the family practitioner was credentialed with local hospital and has a Medicare number. Does he need to do anything to become credentialed to practice in the new location. They want to be in network with BCBS only.

Thanks so much!

 - Charity

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4741
    • Solutions Medical Billing
Re: Group or Individual NPI
« Reply #1 on: September 13, 2008, 04:35:19 PM »
Hi Charity,
   So glad you like our website/forum.  We love to hear it. 

Regarding the 4 drs, if they all bill under one group name and tax ID# then you would bill all under one group npi number in box 32a and 33a.  But you would use their individual NPI #'s in box 24J to show the rendering provider.  However, you must make sure all providers are 'linked' to the group NPI with the insurance carriers you are billing for. 

If the family practitioner was credentialed with the hospital you need to make sure he is now credentialed under the group he is with.  He doesn't need to start from scratch, he just needs to notify the insurance carriers that he has left the hospital and joined a group.  If he doesn't want to be a Medicare provider anymore he should deactivate his Medicare number.  However, if he is considering taking Medicare at the new location, then he just needs to notify Medicare that he switched locations.  He would do that with an 855I form.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

jcbilling

  • Full Member
  • ***
  • Posts: 156
Re: Group or Individual NPI
« Reply #2 on: September 17, 2008, 01:31:18 PM »
Thank you so much Michele! I appreciate your willingness to help and for making my complicated question so simple :)

I do have a follow-up question: Do I need to have all 4 doctors sign a contract? or just the head of the group?

 - Charity

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4741
    • Solutions Medical Billing
Re: Group or Individual NPI
« Reply #3 on: September 17, 2008, 09:05:36 PM »
If you mean a contract with you as a billing service, you just need one person to sign for the whole group.

No problem, we love to help!

Thanks
Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

LW5689

  • Newbie
  • *
  • Posts: 20
Re: Group or Individual NPI
« Reply #4 on: October 06, 2008, 11:08:11 AM »
Michele,
I am going to begin billing for a PT and I am somewhat confused about exactly where to put his NPI#.  I believe I need to put it in 24J and 33a but wasnt sure if I needed to put it in 32a?  He treats patients at a few different facilities and I just wasnt sure if I needed to put his NPI in 33a or if a separate facility NPI goes there?  Thank you so much.  Lori

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4741
    • Solutions Medical Billing
Re: Group or Individual NPI
« Reply #5 on: October 06, 2008, 07:24:04 PM »
You want to put the NPI of the provider performing the service in box 24J (the physical therapist) and the NPI of the where the reimbursement goes in box 33a.  So if the PT is a solo provider billing under his own name (not a group name and tax ID) then you would put his individual NPI in 33a.  Now, box 32a is suppose to be the corresponding NPI for the facility name in box 32 so if the physical therapist is billing under his own name and only has an individual NPI, and has multiple locations in his name, it would be his individual NPI. 

I hope that is helpful and not more confusing!    :-\

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

LW5689

  • Newbie
  • *
  • Posts: 20
Re: Group or Individual NPI
« Reply #6 on: October 07, 2008, 10:18:52 AM »
Michele, I think I am getting it.  But what if the therapist is in addition to his own facility renting space from other proviers would I still put down the treating facility location but with his individual NPI #? in 32a  I thought that the individual NIP # goes anywhere the provider would go?  Forgive my ignorance.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4741
    • Solutions Medical Billing
Re: Group or Individual NPI
« Reply #7 on: October 07, 2008, 09:05:47 PM »
It's not ignorance, that is a good question.  If the PT is credentialed to practice at these different locations/facilities, then even though the facility is not owned by the PT, he technically has a location at that facility.  So you would enter his name, the facility address, and his NPI in box 32.

It's like he subrents space at the facility that he has his own little private practice at (even though it is not 'his' space and he is using their equipment.  I'm just trying to show you what I'm saying.).

Hope that helps.
Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

jcbilling

  • Full Member
  • ***
  • Posts: 156
Re: Group or Individual NPI
« Reply #8 on: October 13, 2008, 09:12:02 AM »
I have a follow-up question about NPI's!

If all the dr's NPIs are linked to the group, does it matter what address is on their individual NPI's? or do they need to update their individual NPI's to reflect their practice address? How do you link the dr's to the group NPI - two of them are currently not linked.

Thanks so much!

 - Charity

LW5689

  • Newbie
  • *
  • Posts: 20
Re: Group or Individual NPI
« Reply #9 on: October 13, 2008, 11:07:55 AM »
Can a provider who has an individual NPI # also be part of a group and have a group NPI #?   Or is it one or the other? Can a provider bill  individually if he provides services separately from the group at times?

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4741
    • Solutions Medical Billing
Re: Group or Individual NPI
« Reply #10 on: October 13, 2008, 12:37:40 PM »
The address on the NPI system does not affect the payment if payment is going to the group, but the provider should have accurate info on the NPI system.  You would need to contact the insurance carriers to have the providers credentialed under the group.  That will link their individual NPI to the group.  Also, if the provider is credentialed with both a private practice and under the group (billing under different tax ID's) then they can bill their private practice under their individual NPI and the services with the group using the group NPI (with their individual NPI as the rendering provider). 

Many doctors have both an individual and a group NPI.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

jcbilling

  • Full Member
  • ***
  • Posts: 156
Re: Group or Individual NPI
« Reply #11 on: November 24, 2008, 01:39:40 PM »
Michele,

One of the DC's that is not linked to the group is currently billing under the main dr's individual NPI # - which I know is wrong and I'm trying to correct. First, the dc needs to fill out a CMS 855R to be linked to the group, right?
But until that happens, I'm considering billing under his individual NPI. The only problem is that he works out of another location in another city part time -and that is the address that his individual NPI reflects on the Enumerator system. So if I submit claims with his individual npi, how do i keep payments from going to the part time office and instead come to the office where I do the billing for? I'm thinking it's the facility address, but I'm not sure.

Do you have any suggestions?

Thanks,
Charity

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4741
    • Solutions Medical Billing
Re: Group or Individual NPI
« Reply #12 on: November 25, 2008, 09:48:17 AM »
If you bill under that Dr's individual NPI  before you link him to the group the claims will probably be denied stating that the ind provider wasn't eligible to bill under the group on the date of service.  If they do pay, it will go to the private practice, not your group.  There is no way around that without doing the 855R form.  Just date it for when you need to start billing, then hold claims until the 855R is processed.  That would be the best way to go.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

mbenedict

  • Newbie
  • *
  • Posts: 1
Re: Group or Individual NPI
« Reply #13 on: February 02, 2009, 07:14:08 PM »
Hi, I'm Marjie and I work for an optometrist that accepts Medicare.   I just completed the mess of paper work required by MCare for a change in the doctor's tax status from sole proprietor to Inc. PA.  I finally got the go ahead, the changes and requirements from MCare had been met so I then billed the claims I needed to.  MCare rejected every one and I'm confused as to how to use the NPI attaced to the doctor herself and the group NPI.  I filled out 24 J with her personal pin and box 32 & 33 with the group pin.  It's only one doctor, so should I use the group NPI that is attached to her new tax ID in 24J and 32, 33? thank you for any help. (I have talked to mcare reps and read the online instructions in the mcare manual and I get different answers!) 

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4741
    • Solutions Medical Billing
Re: Group or Individual NPI
« Reply #14 on: February 03, 2009, 05:37:07 AM »
If Medicare has assigned the dr a group PTAN for her group name and group NPI, and an individual PTAN under her individual NPI, then you would bill with her individual PTAN in box 24J and group PTAN in 32 & 33 A.  But if Medicare only assigned 1 PTAN, then it would be different.  You would need to leave 24J blank and use the NPI that Medicare is using in 32 & 33 A.  When Medicare updated your changes they should have sent you a letter advising you of the update and showing the PTAN, NPI and tax ID they currently have on file.  If you don't have that letter, call Medicare and ask what NPI they have linked to the dr's PTAN.  Even though we don't use PTAN's on the claim anymore they are still a big part of billing.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com