Author Topic: New LLC as secondary practice  (Read 1424 times)

zaremski

  • Newbie
  • *
  • Posts: 2
New LLC as secondary practice
« on: August 04, 2009, 09:08:33 PM »
Hi, I am a partner in a group anesthesia practice.  I am starting a secondary solo practice for moonlighting work.  Obviously, my primary practice is going to continue billing for me via their type 2 NPI.  My questions
1.  Is a solo LLC eligible for a type 2 NPI
2.  When I bill through this new type 2 NPI, do I retain all my insurance company / medicare enrollment credentials or must I reapply with medicare and the private insurers giving them the new type 2 NPI
3.  As a group, our anesthesia practice has negotiated rates with the private insurers.  When I enroll my new LLC, will payment be made at these rates based on my type 1 NPI or will I have distinct rates based on my type 2 NPI
4.  Is there any risk to my primary practice of having reduced rates on reimbursement based on my new type 2 NPI.

Thanks, your help is appreciated.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4701
    • Solutions Medical Billing
Re: New LLC as secondary practice
« Reply #1 on: August 04, 2009, 09:19:04 PM »
1.  Is a solo LLC eligible for a type 2 NPI

Yes, you can obtain a type II NPI for an LLC, even if there is only 1 owner.



2.  When I bill through this new type 2 NPI, do I retain all my insurance company / medicare enrollment credentials or must I reapply with medicare and the private insurers giving them the new type 2 NPI

You need to notify the carriers that you will be practicing separately under your own LLC as well.  Many will make you sign contracts for your LLC, but they don't put you thru the same credentialing process.  Medicare will require you to complete a new application for your LLC to establish it as a new group.

3.  As a group, our anesthesia practice has negotiated rates with the private insurers.  When I enroll my new LLC, will payment be made at these rates based on my type 1 NPI or will I have distinct rates based on my type 2 NPI

No, you will also have to negotiate rates, but they may just accept the same negotiations as you have with the group.


4.  Is there any risk to my primary practice of having reduced rates on reimbursement based on my new type 2 NPI.

Your new NPI should not affect your existing primary practice.

Good luck

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

Steve Verno CMBS, CEMCS

  • Full Member
  • ***
  • Posts: 119
Re: New LLC as secondary practice
« Reply #2 on: August 08, 2009, 07:39:11 AM »
4.  Is there any risk to my primary practice of having reduced rates on reimbursement based on my new type 2 NPI

To add to this question,  we started a new practice and are contracted with some insurance companies. Some of our providers (all W-2 employees) have their own practice and their own NPI number. With one insuance company, I wont give the name, doesnt pay us per our contract. They pay (1) per the patients contract with them or (2) per the contract that our w-2 provider has or doesnt have with this insurance company.  Our claims are correct with the appropriate information when submitted. 

Example:  Our contract payment = 225% of the Medicare allowable.
Dr. Jones is W-2 employee.  He is non par
Dr. Smith is W-2 employee.  He is par being paid 80% of Medicare.

Claim for Bert N Ernie sent to carrier. Dr. Jones treated patient.  Claim payment sent to patient.  Calls to carrier says we are non par group.

Claim for Blondie N. Dagwood sent to carrier.  Dr. Smith treated patient.  Claim paid at 80% of Medicare. Calls to carrier says our contract to be paid at 80% of Medicare.  When Dr. Smith treats his own patients in his own practice, this same carrier pays his claims at 225% of Medicare.  Sounds nice, but he faces constant refund demands and offsetting of his claims payment. 

The problem we face is not universal with every insurance company.  Just with this one insurance company.  We've terminated the contract several times.  Each time they put pressure on the provide to recontract.  We just teminated again and we are now in court to resolve this.  The Hospital CEO terminated the contract we had and revoked all privileges until recontracted.  This too is now in the court system for resolution.  This may not be an issue you will face but serves as an example that even when you do things right, something can go wrong.   We did have some minor hiccups with other insurance companies, such as incorrect payment amounts, checks sent to the wrong address,  but after making calls, they were fixed. 
I'l have a double chubby chuck, a mexicali chilibarb, and two cherry cokes
Left hand Blue, Right Leg Green
You got your peanut butter on my milk chocolate.
Dont cut the blue wire! 
I love spam.