NPI Numbers > NPI Numbers
LLC, tax IDs, and type 2 NPI numbers
therese:
I am a physician who wants to form an LLC with a tax ID. I plan to be out of network, and give my patients a receipt that they can give to their insurance companies. If I want to use my LLC's tax ID for billing, I read that I need to have a group 2 NPI in addition to my individual group 1 NPI. Is it hard to obtain a group 2 NPI? If I am taking cash and only doing out of network billing, giving my patients receipts that they can submit to their insurance company, is there anything I need to do about notifying insurance companies of my group 2 NPI? Is it complicated to maintain a group 2 NPI?
RichardP:
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/downloads/EnrollmentSheet_WWWWH.pdf
https://nppes.cms.hhs.gov/NPPES/Welcome.do
Unless you are practicing in a big city, being out of network for all insurances can make it difficult to attract patients.
therese:
Thanks for the website on how to obtain a type II NPI. I plan to go out of network for now because I am in a big city, but I would like to start a clinic, and my tax ID is under my business name.
What do I need to do after I obtain the type II NPI to maintain it? Do I need to inform insurance companies that I have a type II NPI even though I will be out of network, and patients will be submitting my bill with my tax ID and name of business on it? I guess I am trying to figure out if it is complicated to maintain a type II NPI, or is all that I need to do is go to the website to get a type II NPI, especially since I am not going to credential my business with any insurance companies. What if I decide to work at another clinic as an individual provider and I need to participate in insurance companies there?
PMRNC:
Hold on a sec...
--- Quote --- If I am taking cash and only doing out of network billing, giving my patients receipts that they can submit to their insurance company, is there anything I need to do about notifying insurance companies of my group 2 NPI? Is it complicated to maintain a group 2 NPI?
--- End quote ---
Only providers who are HIPAA covered entities (individual or group) MUST obtain an NPI.
Under HIPAA you are only considered covered entity if you electronically transmit health information in connection with a HIPAA standard transaction or even use a Business Associate (billing company, clearinghouse, etc)
IF you are non par across the board, not going to file electronically or use a billing service, you do not need an NPI.
To read more about this you want to look at following URL: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/NPIBooklet.pdf
RichardP:
--- Quote from: therese on May 26, 2015, 10:22:32 AM ---I am trying to figure out if it is complicated to maintain a type II NPI ...
--- End quote ---
If you can get this clear in your mind, it will simplify things for you:
Type 1 NPI Number - who did the work. (person, who can also get paid)
Type 2 NPI Number - who gets paid. (only for an organization, legal entity, not a person)
You, as a person, can do work - and so you need a Type 1 NPI Number. If that is all you are - a person who does work - then you do not need a Type 2 NPI Number, per the pdf file that Linda linked to.
If you have turned your business into a legal entity, such as a partnership, LLC, or corporation, then that is the entity that will get paid. That legal entity needs a Type 2 NPI Number. If you "own" the legal entity, you can think of the Type 2 NPI Number as yours. But it really belongs to the legal entity you have created.
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If you go to work for someone else (even while you are running your clinic), you will be the "who did the work" for them - and so they will need your Type 1 NPI Number. The person or organization hiring you will be responsible for providing their own Type 2 NPI Number (who gets paid) to those who need it.
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