Author Topic: Can a billing company that represents clinics, hospitals & doctors get a NPI?  (Read 3908 times)

globalbilling

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Can a billing company that represents clinics, hospitals & doctors get a NPI? f so can they that NPI to file for their claims for those clients?

PMRNC

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Linda Walker
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Steve Verno CMBS, CEMCS

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Excellent advice.

A billing company is not a provider and doesnt need a "National Provider Identification Number. 

You are an agent, simply performing a task for the provider, being a go-between, between the physician and the insurance company/patient rgarding claims issues.  Simply put, you are a special employee hired to perfom billing functions. As that agent, You speak on behalf of the provider when questions are asked and claim information is requested.   The tasks you perform are based on your contract with the provider, your training, current industry standards and guidelines and your compliance plan.

Where I live and work, Billing company or Billing agents must register and enroll with Medicare and Medicaid as a billing agent.  A billing agent number will be assigned by Medicare but it never goes on any claim form. 
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Pay_My_Claims

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That's something I didn't know Steve.

PMRNC

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On Medicare enrollments is where the billing agent is to be assigned. It's one of the first things I have my providers do when I sign a new client.
Linda Walker
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Pay_My_Claims

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No, I meant the enrollment part. We didn't have to do that in NC, but I will recheck. I asked about all the requirements, and thus far I have had no issues.

PMRNC

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Form 855I (or the others if applicable) is required to submit certain changes. One of the changes required to be reported/changed is if the "billing agent" is added/changed  You can view this in the instructions with the Form 855I here:
http://www.cms.hhs.gov/cmsforms/downloads/cms855i.pdf   This is a CMS requirement

When I take on a new medicare client this form is included in my packet along with all the clearinghouse paperwork, contracts, etc. I also have another form which allows me to access their PECOS by creating a login. When PECOS first came about, billing agents could not do this, now they can.

In regards to PECOS providers/authorized agents, can change/enroll through the PECOS system by logging in or creating a log in here: https://pecos.cms.hhs.gov/pecos/login.do   If making a change of the billing agent, this also is an option.

So in a nutshell a change of billing agent or the addition of a billing agent DOES require a change in Medicare Enrollment With CMS.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
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Pay_My_Claims

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No, I must not be understanding what Steve posted, I'm not talking about the form(855I) that we complete when the provider is now using us as his billing agent. I thought Steve meant he had to "register" as a billing agent in the sense of PRIOR to having a client.

PMRNC

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Quote
Where I live and work, Billing company or Billing agents must register and enroll with Medicare and Medicaid as a billing agent.  A billing agent number will be assigned by Medicare but it never goes on any claim form.

He'll have to clarify what he meant, but for All States (CMS) the 855 is where they pull the billing agent.   OR it could a separate registration with the state. NJ requires all third party billing companies to register.. whether they are IN NJ or doing business in NJ or both, regardless of who you are billing (Medicare, etc) that's a state level registration requirement and also does not grant you a number or any other identifier on the claim form.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Steve Verno CMBS, CEMCS

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i had a client.  In order for me to bill my Medicare and Medicaid, I had to enroll as a billing agent.  To send claims electronically I had to send a completed EDI agreement with a copy of my contract so they could see I wasnt charging a percentage of what I collected when I billed.  With Medicaid, I had to go to the local police department, undergo fingerprinting and pay for a Medicaid background check just like the providers I enrolled.  This was a requirement in my state and not neccessarily the same in evey state.  Medicare wouldnt let me send claims until I got my billing agent number.  Neither allowed me to send claims electronically until they approved the EDI agreement and I sent sample claims. The file I sent was inspected and had to pass with X% errors.  if I passed, I got a letter saying I was approved to send real claims.  When the practice hired me, they had to send the 855 form to Medicare showing I was their new billing agent.  Again, this is local to where I am here in Florida.  I didnt have to do this when I was in New York. 
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.

PMRNC

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Steve, actually that's pretty impressive you had a client that went through due dilligence. I cringe every time I see a biller in those states charging a percentage and their only reason is "everyone else is doing it" Even though the biller isn't doing anything illegal, their providers are. And a lot of states have it on record you can't bill a percentage to Medicaid but you would be surprised (or probably not) how many don't know this or ignore it simply because everyone else is doing it.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

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Not to get picky, but the CMS 855B also has a section for reporting the billing agent so if you are picking up a group with a group PTAN (not a sole owner - because that can be done on the 855I) you would do section 8 on the 855B.

As far as EDI, most states do require the billing service to complete paperwork to be assigned a submitter ID to bill claims electronically, but they can submit on paper (if they want to) without it.

Michele
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PMRNC

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You can get your submitter ID before even getting clients and then link it later.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Pay_My_Claims

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OK, that information I do know about, however what Steve had to do....not required in NC :-)