Author Topic: NPI Nightmare!!!!!  (Read 1746 times)


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NPI Nightmare!!!!!
« on: April 22, 2008, 02:42:30 PM »
We are a Skilled Nursing Facility.  We have our NPI number and have been using it.  It is our responsibility to provide Physician Services to our residents and have contracted with a doctor to come into our facility to perform these services.  This doctor also has his own private practice with another group of doctors.  As part of his contract, we bill his physician services using his Medicare Part B Number so his private practice staff does not have to do this.  His Medicare # is attached to our Tax ID number and when the money comes to our facility we turn the $ over to him.  We have been doing this since 1968 and all has been going well until NPI!!!!!  The problem actually started when the crosswalk with Medicaid started for Physician services billing.  Some of our Medicaid residents showed up on his private practice Medicaid RA.  I was told it was because of his NPI that is attached to his Medicare # and the NPI is attached to his private practice.  He does not want any $ from his services at the nursing home to go to his private practice.  I was told that I needed to fill out CMS-855I to that we would be established as the location and he would be the rendering physician.  Medicare now has told me that form 855I was the wrong form and I need to complete 855B & 855R.  To establish a new Medicare Part B number for the nursing home and to reassign his beneftis to our Tax ID.  Medicare guidelines for a skilled nursing facility state that we cannot bill for physician services that is why we were billing for doctor under his Medicare #.  Medicare is stating that his Medicare # is no longer good and because the $ comes to the facility first, doctor is viewed as an "employee" and therefore we need a new Medicare # with the facility NPI attached to it so we can continue to bill for his services for him.  I'm just not sure that we would qualify for an additional Medicare # because we are not suppose to bill for physician services.  Can anybody offer any advise????!!!!!   Help!!!!!   


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Re: NPI Nightmare!!!!!
« Reply #1 on: April 22, 2008, 09:17:07 PM »
Wow, this is quite a mess for you!  I'm afraid the only way out is going to be a bit of paper work.  It sounds like you are going to need to get an NPI number that will belong to the Dr but for the tax ID & location of the nursing home.  However you cannot do that the way things are because the NH (& it's tax ID #) already have an NPI and like you said, Medicare will not allow you to sign up a Dr under the NH.  So if the dr got a new tax ID number, just for his NH visits, then applied for an NPI number under the new tax ID & 'group' then you would have to apply for a Medicare # for the group (855B) & for the dr at the NH location (855I) and an 855R to reassign the benefits.  If the Dr's private practice is under a group name, and not the Dr's personal name, he could apply for a tax ID under his name, then he wouldn't have to complete the 855B or the 855R.  Their is still a problem with Medicaid.  In order to resolve that you need to get either his private practice, or his 'new group' to become a medicaid group provider.  That way, when he bills for whichever location becomes a group, he bills under a group medicaid provider # for the payment info.  Then he can use his individual number for the other location.  I hope you can follow this.

My brain hurts.

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