Medical Billing Forum

NPI Numbers => NPI Numbers => Topic started by: Christine_1 on June 10, 2008, 07:32:24 PM

Title: Huge Mess
Post by: Christine_1 on June 10, 2008, 07:32:24 PM
Love this website!! Thanks for all your answers.

Now, to my huge mess.
We have 2 offices owned by the dr. (sole proprieter). Both offices are RHC's. For Medicare we have 3 provider #'s, same with Medicaid. The dr. has a RHC provider # for each office and then a seperate provider # for all services not billed as Rural Health. When applying for our NPI we got 1 npi. Then we were told he would need a npi for each provider number. We got a second npi and when we tried to register the 2nd with medicare we were told, he only needs one he is a sole proprieter and only has one tax id. So we had the 2nd deleted. GUESS WHAT??????? Since the implementation of the NPI we have not received payment from either because they say when the claims go through edits it is kicked out because it doesn't know what provider # to assign the claim too. I have been calling our FI daily to see what can be done. I was told at one time they will seperate them by zip code. This hasn't been done yet. We are a very small practice and to stop our medicaid and medicare payments is cruticial. That is probably 90% of our claims. Any advice is GREATLY appreciated.  ???
Title: Re: Huge Mess
Post by: Michele on June 11, 2008, 09:19:35 PM
   Wow, sounds very confusing!  Anyway, if the Dr uses the same tax ID# for both locations then it sounds to me like he would need a Type I NPI for himself, but a Type II NPI for his group name & tax ID#.  Even if his group name is his own personal name, since he is billing under a tax ID# he should get a group (Type II) NPI. 

   Then you should bill using the individual NPI to identify the provider, but the group NPI to identify where (and under what tax ID#) payment is to be made.

   If the provider is listed with Medicare as a group, then he would need a group NPI.  If he is listed as just an individual doc then he should only need the individual NPI. 

    I'm surprised that calling Medicare hasn't straightened this out.  Usually they are good at telling you exactly what the problem is so that you can rectify it.

    I hope this info was helpful.  If not, and you have any other info to give me, respond and we will try to help you get to the bottom of it! 

Good luck!  :)
Title: Re: Huge Mess
Post by: Christine_1 on June 27, 2008, 03:45:32 PM
Thanks for your reply. We still do not have this mess straight. We are over a month now with no claims paid by medicare (85% of our patients are medicare!!). I enlisted the help of our medisoft vendor, as I couldn't get anywhere. We only have 1 tax ID#. The latest is vendor called medicare and was told to replace the drs tax ID# with his SS#. He has done this. Then we had to contact BC/BS of Tenn (FI) to update this information and were sent a form to fill out and was told this process could take up to 30 days. The dr is steaming and is ready to close both his businesses and work in hospital ER. I just don't think this new fix sounds like it is going to work. I also see this affecting our other payors when this change happens. I do agree with you that medicare usually will tell you what you need to do, but at this point I don't think they have a clue.
Title: Re: Huge Mess
Post by: Michele on July 03, 2008, 08:50:19 PM
I have seen cases like this before.  The Dr had been with Medicare for a long time and had forgotten that he enrolled in Medicare using his SS# instead of a tax ID#.  It sounds like that may be the case with your situation.  Have you asked Medicare out right if the dr's PTAN (Medicare provider number) is under his ss#.  If that is the case, the claims just need to be resent under the ss#.  I'm not sure why this would take 30 days.  Unless they are telling you that you need to complete the paperwork to switch it over to the tax ID.  In that case it would take some time.  It also can cause problems if Medicare forwards the claims on to the 2ndaries under his ss# they may be processed out of network. 

The best thing to do would be to get Medicare set up under the tax ID#, but that will take time.  The Dr will have to be patient :)

Good luck