Author Topic: Single Member LLC Tax ID  (Read 10580 times)

evans1035

  • Newbie
  • *
  • Posts: 7
Re: Single Member LLC Tax ID
« Reply #15 on: October 01, 2010, 06:10:04 PM »
Medicare nightmare (continued)...
Because Medicare backdated the deactivation date of old ptan and npi to 3/5/10, and made new grp ptan and grp npi effective 5/26/10, they are not going to pay her for charges to these patients, technically from 3/5 until 5/26/10 dates of service (although they had already pd 3/10 dates before they sent whatever they sent to the old address). In one of their letters they say something that they have to at least make eff date of new # back 30 days, which would be 4/26. When I asked rep about it, she said oh, that's for revalidation, and this is now considered a new application, so it doesn't apply.
 How do you ever know if the rep you're speaking to has any clue about all of this?
THIS IS DROWNING ME!!! Provider is also worn out from all this, and says just bill under the new #. She wants me to also rebill the charges in that gap also and see if they pay. From what I could figure out from the 42 CFR 524.520 they quoted, that could cause more trouble and I left her a message to that effect.

Sorry this is so long, but I have so much paper from this nightmare, it's hard to explain everything.

My actual question at this point is: What do I do about all the other carriers (BCBS, Medicaid, UHC, Aetna, etc.)? I've always submitted all those on her tax ID and had her address on claims, and 1099s she gets from them show her tax ID #, so do I tell them she now has a grp NPI? What if Medicare and other carriers ask for money back? This was not any attempt to defraud anybody, and as I said, it is just her in her practice. I'll have her Sept billing in the next few days, and I don't know what to do about the NPIs or how to ask carrier about all this without having more issues.
DID I MENTION THIS IS DROWNING ME? I WANT TO QUIT BILLING NOW. THIS IS MAKING ME PHYSICALLY ILL...

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: Single Member LLC Tax ID
« Reply #16 on: October 01, 2010, 07:00:19 PM »
I can only offer you what I went through.

You won't have the same run around with other insurance companies.  Just call provider relations as you have time and find our what they want you to fill out.  We ran into the same thing with a group NPI vs. individual NPI.  We were just a sole proprietor so the group NPI we were told to get was wrong.  Long story short, regular insurance companies will have A form and will make the changes easily.

Medicare, on the other hand, was a nightmare for us when we moved our office.  We happened to do this right when they were changing vendors too.  So a one line address change took me 9 months.

Fill out the application form being extremely careful to dot all the i's and cross all the t's.  When you show the doctor's SS#, EIN, PTAN, and NPI they will finally all be joined on one form.  You can then show the old address start and stop dates AND the new address start dates.

Once they have it scanned in their system, you can speak to someone who has it all on their screen.  The hold time on the phone is a killer, so set aside a day and time to devote to it and be patient.  It sucks, but it has to be done. 

Your doctor will have to switch to EFT if they haven't already done so.  Medicare is eliminating checks.  I was scared to do it, but it has worked great so far.

It took a long time for me because I didn't know what I was doing.  I ultimately got it right, and we got paid on everything.  I'm ashamed to admit it, but I cried when the first payment came in.  Seriously.

Best of luck to you, and if you need help finding the right phone numbers I'll gladly help you!

This is a great forum and all the people here are so helpful.  We've ALL been where you are!

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4766
    • Solutions Medical Billing
Re: Single Member LLC Tax ID
« Reply #17 on: October 04, 2010, 07:44:33 AM »
The problems that you are describing are the reason that we started doing Medicare credentialing as a service.  Many providers that just move their location, or change from their ss to an EIN, but do not know how to do the paperwork Medicare requires, end up with a huge headache, or losing a lot of $$.  Once you understand exactly how Medicare works and what they require it is not as much of a nightmare.  I don't mean to minimize the situations you went thru because I completely understand.  But having done over a thousand Medicare CMS forms, I know exactly why Medicare requested what they did, and why the provider/biller didn't understand.  Since most providers/billers don't need to complete CMS forms on a regular basis they do not know what needs to be completed and why.  AND lets not forget to mention that Medicare often "updates" the CMS forms, which changes the whole thing up just a little!   ;)
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

dekenn

  • Jr. Member
  • **
  • Posts: 77
Re: Single Member LLC Tax ID
« Reply #18 on: October 04, 2010, 11:42:50 AM »
How long do we wait for Medicare (we are under Highmark Medicare) to assign the application to a reviewer?  I submitted the new application online (we weren't in Pecos, and had to switch from his ssn to ein), got the certified mail confirmation (mailing in the certification statement and EFT form) on August 9.  Finally called last week, the rep confirmed they received it, but it has not been given to a review yet.  At what point can we complain about the delay?  Any one else experiencing these delays???

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4766
    • Solutions Medical Billing
Re: Single Member LLC Tax ID
« Reply #19 on: October 04, 2010, 08:48:23 PM »
Per CMS guidelines, they (Highmark) have 120 days to complete the application.  If they require additional information or corrections, the 120 days starts over from the date they receive the corrections.

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

evans1035

  • Newbie
  • *
  • Posts: 7
Re: Single Member LLC Tax ID
« Reply #20 on: October 11, 2010, 10:22:51 PM »
Ok, so from what I could tell from Medicare's IVR system (when I could get a response and it didn't hang up on me), they say all the claims I resubmitted under her new group npi have been approved to pay and the amount, although it is apparently too soon for them to have actually sent the funds to her bank acct.
  Now my next problem is to figure out what needs to be done with the commercial carriers as far as her npi. I believe her indiv NPI is already attached to her tax ID #, since I was seeing both on some of the carrier eobs (like Aetna and United Beh Hlth), but then which npi needs to go in now on claims? Do both NPIs go in and if so, which one goes in which box?  I called United Beh to see where to send a notice of the new NPI and the person I spoke to told me that they will only go back to the beginning of the month they get the notification, so I called my clearinghouse and told them to send the 9/10 claims with the indiv npi on them when I resend them, so now I'm trying to make sure it goes to clearinghouse with correct npis in correct places.
I am going around in circles at this point, I think.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4766
    • Solutions Medical Billing
Re: Single Member LLC Tax ID
« Reply #21 on: October 12, 2010, 07:05:38 AM »
It is really better to have all insurance carriers set up with the same info.  I would go for the individual NPI for the rendering provider (box 24J on the CMS) and the group npi & EIN for the billing provider info.  EIN in box 25, Group NPI in box 32A & 33A.  I would get all carriers set up that way ASAP, otherwise you are looking at a billing nightmare, especially on claims that are crossed over by Medicare.
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

evans1035

  • Newbie
  • *
  • Posts: 7
Re: Single Member LLC Tax ID
« Reply #22 on: October 12, 2010, 09:08:30 AM »
Michele,
Thank you so much for the response. From everything I've been reading, I can see that's how it should be, but I'm still unclear as to if she needs a new indiv npi under her group npi, or can just use the one she's had all this time.
  For Medicare, my clearinghouse person said they sent the new claims in with both her individual NPI and new organizational NPI on them. I just checked the automated system again and they said all those claims are processing, and that approved amt is 64.41 and pd 51.53. I'm hoping the reason no funds have been disbursed yet is that it hasn't been 14 days yet.
  Also, when I checked on the automated system, I put in her group PTAN, not an individual PTAN. My clearinghouse said on the claims Medicare no longer wants to see PTANs anyway, so they were sending in both old indiv and new NPIs, so I'm worrying that since they deactivated her old indiv NPI they won't actually pay in spite of what the automated system said. Thanks for the help. Carol

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4766
    • Solutions Medical Billing
Re: Single Member LLC Tax ID
« Reply #23 on: October 13, 2010, 06:51:48 AM »
A provider can only ever get one individual NPI.  That stays with them for ever.  They would never have two individual NPI's.  It sounds like you should be fine from this point.

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

evans1035

  • Newbie
  • *
  • Posts: 7
Re: Single Member LLC Tax ID
« Reply #24 on: October 13, 2010, 09:49:37 AM »
Thanks for the response Michele. It took a long time to sink into my head that the identifier is just that, and identifier, not a tax id. I've been calling my client's main carriers to see what they will require to add the org npi. Not only does every carrier give different answers, but the people don't seem to clearly know the answer either. I called BCBS of CO yesterday after looking on their website. There is a provider change form there and on there it says "You do not need to do a W-9 if the TIN is not changing." Well, it's not, and all the carriers with exception of Medicare had her TIN tied to her indiv NPI anyway, yet woman @BCBS says we have to fill out a w-9 and send a formal letter to add the org npi. I kept asking for clarification of why the website said one thing and she was telling me another, and she let me speak to the supv who also said we had to do the w-9. How do I straighten things out when the carriers' online info and prov svc reps don't say the same thing?
Carol

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: Single Member LLC Tax ID
« Reply #25 on: October 13, 2010, 01:52:13 PM »
I hate that too when different carriers want different things. I usually just comply as it's much easier than arguing. I would go ahead and give them the W9.  It might be that the previous TIN didn't match the W-9? They ALL have to match exactly with their Tax information.. right down to crossing the t's and dotting the i's.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com