Question on starting a group practice

[bellinghausen]

I work with a couple counselors who are considering staring a group practice.  If they decide to and get a group NPI to bill under, do each of them still get individual payments from insurance or do payments come to the group and then have to be divided out?

[PMRNC]

They will get paid as a group. How they go from there is beyond the scope of the biller/practice manager as it's somewhat of a conflict of interest. They should have a clear structure on their practice and how the group will function in that regards.

[bellinghausen]

Thank you, that helps quite a bit. 

[bellinghausen]

OK, I passed on your information and some other facts to the counselors and they want to continue to bill as their own practices but just market and combine for rent, etc.  Now, my question is that one of the practitioners wanting to join efforts will be part time and will continue to work with another group where he already bills as part of that group.  One of the insurance companies is tell them they need to get an NPI 2 number for him to bill as part of their group but they aren't going to bill as a group.  Can he bill just under is own Tax ID/NPI or is there something else that needs done since his name will already be connected with a group #?  I am confused.  Thank you for whatever help anyone has.  :-)

[Michele]

He needs to make sure insurance carriers have him set up privately under his individual NPI for the private work, and linked to the group he works for, when seeing patient there.  When he bills privately he will just bill with his ss# & individual NPI.  When the group bills, they will use their EIN/Group NPI and his individual for the rendering provider.  It's done all the time.

[bellinghausen]

Thank you very much. 

[Pick3dlast]

Mostly the only time an insurance company pays a provider that renders services somewhere other than where he is affiliated is for ER in a hospital setting or inpatient settings. these are referred to as downstream providers at this point. Otherwise the case is very unlikely. There is typically one NPI associated to each provider and practice, however the provider can choose to be credentialed through as many groups as he can handle. The individual NPI stays the same it would just be billed with the new or additional groups TIN. A provider would simply have to go through a usually 6 month credentialing process to have this done through each insurance company that the additional group is contracted with.