Author Topic: Will NPI application for national rehab CO interfere with my private practice  (Read 2388 times)

mjwriley6

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I am a Colorado physical therapist recently employed on an on-call basis by a large national provider (contract Rehab in SNFs, ALFs, private pay Part Bs).  They want me to get an NPI number so they can bill if I treat "an agency-direct bill patient". 

Questions:
1. What is an "agency-direct bill patient"?

2.Will getting this NPI for the national company, in any way create a problem or influence me getting my own NPI for the physical therapy company I wish to soon start on my own.   I am only doing the on-call work to supplement my income while I grow my own company.

3.  In starting my business---at what stage do I need to get my NPI number?  Will I need a second NPI for the company itself?   Should I get both only after I have a business license? 

4.  I plan to initially have independent contractors work for my company.  What requirements will there be for each of them to have an NPI number or will they bill under the companies number?

5.  Getting started,  can I bill and work as a sole proprietor under just my own NPI---then as business grows switch to an LLC or S-Corp and then get an NPI for that new entity?

Thanks---grateful for answers to any and all.

Michele

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Questions:
1. What is an "agency-direct bill patient"?    You need to ask the agency this.

2.Will getting this NPI for the national company, in any way create a problem or influence me getting my own NPI for the physical therapy company I wish to soon start on my own.   I am only doing the on-call work to supplement my income while I grow my own company.    You will be obtaining an individual NPI, that will stay with you whether you work for this agency or for yourself.  It will not create a problem.  You will be getting your own NPI now, but they will be using it to indicate that you rendered the services for their agency.

3.  In starting my business---at what stage do I need to get my NPI number?  Will I need a second NPI for the company itself?   Should I get both only after I have a business license?    You need to get your individual NPI now.  If you establish a company, you will need a type II NPI for that company once you establish it.  You should get your individual now, and your group once you have a legal business name & EIN number.

4.  I plan to initially have independent contractors work for my company.  What requirements will there be for each of them to have an NPI number or will they bill under the companies number?      They will need their own individual NPI numbers and you will have to credential them under your group.

5.  Getting started,  can I bill and work as a sole proprietor under just my own NPI---then as business grows switch to an LLC or S-Corp and then get an NPI for that new entity?      yes.
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mjwriley6

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Thank you for your answers!   If I am billing for myself, during concurrent periods as the national company is also billing people I treated (using my NPI)-- is it the NPI-II   that makes sure CMS pays us each correctly? 

Michele

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It's how you are set up with each insurance carrier.  They must be notified that you are working for the agency.  Then when the agency bills they use your individual NPI in box 24J to indicate rendering provider, and their group NPI in box 33a to indicate who to pay. 

They all (insurance carriers) must also be notified you do private practice as well.  Then when you bill you would put your individual NPI in box 24J (rendering) and your personal info in box 33.  So if you have a group name & group NPI you would put it in box 33.  If you don't and you are billing under your name and ss#, then your name and individual NPI would go in 33.

Michele
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