Author Topic: Group or Individual NPI  (Read 15608 times)

powerbilling

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Re: Group or Individual NPI
« Reply #15 on: March 24, 2009, 06:46:27 PM »
Hi Michele,

I just wanted to thank you so much for your knowledge. I've been running a medical billing company for about 8 years now and over the last year have had nothing but issues with Medicare, Blue Shield and Blue Cross and the Group NPI # for Box 33A. After reading thru your posts I found my answer, and fixed the problem. What has taken me a year to try to fix I was able to fix in less than 30 minutes doing some research with your site and verifying with my software company.

I will be checking out the posts here every week! Great work! Thanks again!

Michelle P.

Alice Scott

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Re: Group or Individual NPI
« Reply #16 on: March 25, 2009, 05:44:27 AM »
Michelle,
Thanks for your kind words.  We're glad we could be of help.  We all run into problems no matter how long you are in this business and we believe this is the way to help each other. 
Alice
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PMRNC

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Re: Group or Individual NPI
« Reply #17 on: March 25, 2009, 06:08:13 AM »
NPI was a big pain in the butt for all of us I'm sure. The biggest problem I seen was the doctors not UNDERSTANDING how the NPI application and info had to match their IRS file. The second biggest problem I had were with a few clients that were using the same clearinghouse and we found out the errors were on their end. I still have one provider with an issue that is split   ::)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

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Re: Group or Individual NPI
« Reply #18 on: April 17, 2009, 09:27:04 PM »
This drives me crazy too.  I had a dr today that is trying to update their info with Medicare and the NPI (Type II) doesn't match the business name exactly.  The dr is crying that Medicare is being ridiculous.  I tried to explain, but ahhhh  --  it just doesn't sink in.  :)

Michele
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thatcuteblonde

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Re: Group or Individual NPI
« Reply #19 on: October 07, 2009, 02:58:50 PM »
I wanted a quick add on to this, I have Medisoft, same scenario. Set up a group NPI through the provider Class screen and set up and individual through the NPI within the provider but have gotten rejections. Any suggestions?

Michele

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Re: Group or Individual NPI
« Reply #20 on: October 08, 2009, 05:46:26 PM »
Are the rejections from Medicare?  You need to call Medicare and verify the Group PTAN, NPI & EIN number to make sure their files match what you are billing.

Michele
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tsbrown

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Re: Group or Individual NPI
« Reply #21 on: October 20, 2009, 11:33:19 PM »
Hi everyone. 

I just  received my Licensed Professional Counselor (LPC), Licensed Professional Christian Therapist (LPCT), and Certified Anger Management Specialist (CAMS) back to back.  I have a non-profit organization (working with homeless and working poor) which I've had since 1992.  I want a private practice and don't know if I should put it under my non-profit or make it profit.  The question is I don't know anything about medical billing and want to apply to become a provider for insurance companies.  I don't know if I should do it as a group or individual but I'm leaning toward putting the counseling center as a program under my nonprofit.  I don't have enough money to pay someone to bill for me yet, but does anyone have any suggestions about anything I've said.

Michele

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Re: Group or Individual NPI
« Reply #22 on: October 21, 2009, 07:51:26 AM »
Congratulations! 

As far as your questions, you need to decide if you want to bill under your ss#, or an EIN number for your private patients.  Also, are you going to have other counselors work for you in your private practice?  Many people form a corporation even if they are an individual for liability purposes.  I can't really advise you on whether to make it a program under your non profit company. 

Once you decide on these things you will need to contact the insurance carriers and ask them what you need to do to get on their network.  They will help you begin the credentialing process. 

Good luck!

Michele
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PMRNC

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Re: Group or Individual NPI
« Reply #23 on: October 21, 2009, 08:36:28 AM »
Have to ask... WHY?  Many states have limitations on LPC's and many carriers also won't credential them. You are doing a great service I'm sure but do you want to have to completely change your thinking.. you won't be able to have the kind heart to discount patients anymore, non-profit and medical practice don't really go hand in hand, you'll have to completely change your way of practice :(  sounds harsh but Realistic!   Why not go to a private practice and be cash only provider, or maybe look into concierge care, so many options.. I wouldn't leap into the world of insurance without really looking at all the ramifications.  JMO   Give a discount or free care now and you are a wonderful person, give one later when you are in private practice accepting insurance companies and you could find yourself sanctioned or worse.
Linda Walker
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tsbrown

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Re: Group or Individual NPI
« Reply #24 on: October 21, 2009, 03:17:13 PM »
Thanks so much.  I'm not sure I understand your excellent answer because it was jam packed with mysteries for a newbie.  HELP!  I never even charged before during the 18 years of non-profit, but I have met my educational goals and need to bring money in now that I am licensed.  Please tell me what you mean by state limitations?  Carriers won't credential?  I will have to change my way of thinking completely?  So would you suggest LLC based on your experience (just asking your opinion)? What's concierge care????  Ramifications from using insurance?  Sounds like insurance for my profession isn't the greatest idea although I know a lot of centers use it.  I don't understand the pros and cons (that's a lot for this site I'm sorry can you suggest how I can research this).  Why would insurance sanction me for doing probono, it's encouraged in our profession by licensing board?  I'm sure when I have these answers I will understand why you're suggesting cash only.  Thanks so much.  Sorry I'm so ignorant right now.  Time heals all.   

PMRNC

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Re: Group or Individual NPI
« Reply #25 on: October 21, 2009, 07:06:49 PM »
Your not ignorant at all. Those are all questions you should be asking.
You have to research whether LPC's are recognized in your state, some states don't recognize them ..research "scope of licnese," and your state. As for the structure of your business, I suggest an accountant to advise you. Their are pro's and con's to Incorporating, LLC's, etc.

As for sanctions.. I'm sorry I should have explained. I have worked with various mental health providers who like you have done their fair share of pro-bono, charity and non-profit work. It's great for the soul but when it comes time to get into private practice what I have found is that most providers are not practical nor in the right frame of mind to get ready for the changes they have to make. For example, a patient presents with insurance coverage and either a $10, $20 copay or maybe 50% coinsurance and they don't have the money to pay their portion, it's actually "illegal" to routinely waive or discount the patient's cost-sharing with their carrier. With that said you have to be ready for the adjustment in the way you do business. Developing office policies, procedures, compliance manuals, etc all goes into this before you open your doors and even before you credential with the carriers you choose to credential with. When you begin accepting insurance the game changes .. completely.

My advice would be to find a good practice management consulting team to help set you up, get you educated, credentialed, get your office and policies done, HIPAA compliance, HITECH compliance..etc etc etc. 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

tsbrown

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Re: Group or Individual NPI
« Reply #26 on: October 24, 2009, 03:26:40 PM »
Hi Everyone.

Alice and Michele this site is awesome, especially for a newbie.

Linda, I appreciate you so much.  GA does recognize and license LPC's.  I was licensed by GA Professional Licensing Board.  I did some reading and understand more what you mean about change my thinking.  In my new book, " The Paper Office," I saw things on balance billing like "if the MCO rejects your claim for payment..., your can only collect the copayment and not the rest", that's scary.  You're right, it is illegal not to charge the copay except I have an indigent clause clearly defining indigent and you should heavily document the clients indigence through investigation of the source of income or lack there of and not offer it, but let them ask.  I am still confused with your terminology of insurance companies credentialing us?  I don't know if insurances reimburse LPC's or if the organization has to be headed by a psychologist.  Linda, I have been reading about NPI's but am still a little confused.  I can apply for one individually using my ss# and that allows me to work anywhere and bill individually?  Or does that have to be associated with an address and business?  I have decided to do an LLC for profit but don't have start-up yet because rebounding from a son with cancer.  I have a choice to get a group number and attach it to my non-profit "group" since it already exists and switch it over in a few months when I can start the profit?  Can the group number switch from a nonprofit to a profit company or is it stationary?  I probably will not reach the amount of money for salary that will effect the non-profit in say three months anyway (it's been mostly inactive this year because of the cancer).  You can make a certain amount before you have to report or file taxes.  Or can I do the indigent counseling under the non-profit and keep the group NPI there, do an individual NPI for my for profit and also use the individual NPI if I do work with for other organizations?  Now, I feel like I am starting to know what kind of questions I really need to ask.  I am trying to read so I don't feel so lost.  I've always said I have a lot of degrees, but the more I learn the more ignorant I get because the more I realize I have to learn.  Thanks so much for your attention and help.

PMRNC

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Re: Group or Individual NPI
« Reply #27 on: October 24, 2009, 03:53:47 PM »
Wait until you decide on your structure of business, practice location, etc before applying for your NPI. Your NPI number must EXACTLY (right down to crossing t's and dotting i's) your Tax record. If there is ANY difference in the two files, claims will get rejected.

Some insurance companies have closed panels and some plain don't credential LPC's, you have to contact the ones you are interested in and they will tell you the credentialing procedure.

Your indigent policy is RIGHT on the money.. your office policy should clearly define indigence and then you document on case by case basis.
Linda Walker
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www.billerswebsite.com

tsbrown

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Re: Group or Individual NPI
« Reply #28 on: October 25, 2009, 12:26:48 AM »
Thank You for This Site!!!  The Newbie. 

I am a preacher and I want to say I really feel blessed by God to have found this site.  Opening a new business is a serious undertaking and there's so many new things to know and do.  I find myself obsessed with reading it; things that effect me, things I don't understand "yet", and just hungry for the knowledge that is here.  People are real, personalities shine through and the openess and friendliness is astounding.  What it has done for me, a newbie, is pushed me to study and learn.  Because of this site I spent hours reading, "The Paper Office (especially a very revealing  look at games MCO's play in 'Ethical and Legal Issues in Working with Managed Care Organizations')," it's many internet references, other internet sites and this site.  Your site is thought provoking, challenging and jam packed with experts and/or people who are willing to share what they have.  It stirs my thirst for knowledge and drives me to learn more both on my own and from the site as a soon to be new business owner. 

Thanks Sooooooooooo Much.

P.S.  Especially you Linda for following through with me.

PMRNC

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Re: Group or Individual NPI
« Reply #29 on: October 25, 2009, 02:19:05 PM »
You are very welcome! Keep us updated! 
Linda Walker
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