Author Topic: Provider or Vendor  (Read 2704 times)

Niosh

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Provider or Vendor
« on: January 02, 2011, 10:11:57 AM »
Sorry if this is a basic question but I just can't seem to find an answer anywhere. So my spouse just recently/is in the process of starting her own practice. In order to shift some of the workload from her I thought I could help and do the billing for her. So my question in this respect is do I need to fill out registrations as a provider or as a vendor? I'm currently working my way through the Medicaid EDI and at some points I feel like we can do everything as a provider but then some times I feel like we should be compartmentalizing ourselves as a provider and a vendor. She already has a personal NPI, practice NPI, as well as tax ids and various other long numbers :).
If it sways the answer any, depending on the success of this I might extend my billing services in the area (at which point I'm certain I would have to become a vendor), but in the mean-time can 'we' be the provider?
Thanks in advance for any help, I am sure I will spend a lot of time reading through this forum in the future.

PMRNC

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Re: Provider or Vendor
« Reply #1 on: January 02, 2011, 10:36:16 AM »
First, it's not clear what you mean by vendor, I don't know your legal status with your wife's practice.. I would also have to say you might want to consult with an attorney to be sure you are not violating any STARK regulations if you are a part owner/investor of the practice.
If you are going to simply provide the billing, I see no reason why you shouldn't be setup as just an employee?  If you are a billing company you will need to let Medicare know via a change form that you will be the billing agent.


I guess it all depends on your legal setup with your wife, but I would consult with an attorney to be better prepared because the industry has a lot of regulations you will want to be aware of and make sure you are setup properly in compliance.

Also you don't mention your experience with billing or practice management, If you do not have any formal training or education, or experience you might do more harm than good for your wife's practice.
Linda Walker
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Niosh

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Re: Provider or Vendor
« Reply #2 on: January 02, 2011, 11:03:10 AM »
Vendor is the term I see used for various billing service providers or agents, and so that is what I mean by it.
It's a solo practice entirely in her name and we were thinking about setting me up as an employee but can I be an employee that gets paid nothing? I guess I could get paid some amount but it seems that would create a mess for tax purposes.

I wouldn't think it would violate any STARK regulations considering if she were doing it all herself she would have the same financial interests as I would.

I have no formal training in medical billing (does is really show that bad) and my experience is limited to other health care fields (no billing), I'll certainly step aside if I think harm will be done.

Michele

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Re: Provider or Vendor
« Reply #3 on: January 02, 2011, 06:11:44 PM »
What type of provider is your wife?
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Niosh

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Re: Provider or Vendor
« Reply #4 on: January 03, 2011, 01:15:31 AM »
What type of provider is your wife?
She is an ARNP specializing in family practice and shortly in psych/mental health once she finishes the clinical hours. This is a new clinic and so the patient load will be fairly small.

Michele

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Re: Provider or Vendor
« Reply #5 on: January 03, 2011, 07:38:22 AM »
Do you have any resources to assist you in learning the billing?  If the patient load is small and you have resources to make sure you are doing things correctly, it could work.  The concerns would be that a lot of money could be lost, and also, if things are not billed properly there could be ramifications such as fraud (unintentional of course - but still fraud).  Is your wife familiar with how to code her own services?  If she is familiar with the coding that is a huge help.  If she isn't, it would be difficult.  Also, do you have a practice management system? 

I wouldn't think setting up as a vendor would be beneficial in the beginning.  I don't know about being an employee with receiving $0 pay, but I know that spouses "help out" their provider spouses all the time.  I just don't know the legal ins and outs. 
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PMRNC

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Re: Provider or Vendor
« Reply #6 on: January 03, 2011, 07:51:00 AM »
Quote
I wouldn't think it would violate any STARK regulations considering if she were doing it all herself she would have the same financial interests as I would.

That's exactly why an attorney should be consulted.

I would not go into this without legal consultation.
Linda Walker
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Niosh

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Re: Provider or Vendor
« Reply #7 on: January 03, 2011, 05:37:28 PM »
She is in close contact with two of her preceptors who both have started their own practices years ago. Otherwise we were looking at getting a few books or taking classes of some sort. Long term she doesn't want to see a large volume of patients, maybe 30 or so per week.

When you say practice management system do you mean some type of EMR software or a business plan?

I think for now I'm going to avoid setting up as a billing agent. I really appreciate your help on this, thank you.

Michele

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Re: Provider or Vendor
« Reply #8 on: January 05, 2011, 09:22:21 PM »
EMR is for records.  Practice Management system is for billing.  Some PM's contain EMR, and vice versa.  You really need some form of PM system not only to submit claims, but to track, record payments, and run reports.

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PMRNC

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Re: Provider or Vendor
« Reply #9 on: January 06, 2011, 07:35:55 AM »
Not to sound harsh, but PLEASE get someone experienced to start your wife off and learn that way rather than the other way around. The beginning is a chance to start off on the right track and learning as you go and begin is not going to benefit her at all and in fact could do much more harm than good.
Linda Walker
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Niosh

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Re: Provider or Vendor
« Reply #10 on: January 06, 2011, 08:37:09 AM »
Not to sound harsh, but PLEASE get someone experienced to start your wife off and learn that way rather than the other way around. The beginning is a chance to start off on the right track and learning as you go and begin is not going to benefit her at all and in fact could do much more harm than good.

Oh, don't worry about sounding harsh, this will be our livelihood and the last thing we want is to mess it up by losing money or worse with legal trouble. She's going to sit down with her current preceptor in the near future to talk about billing and she currently works one day a week at her old preceptor's office and she'll be talking with him too about how he runs his practice.

Michele

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Re: Provider or Vendor
« Reply #11 on: January 06, 2011, 11:56:13 AM »
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but PLEASE get someone experienced to start your wife off

EMPHASIS on SOMEONE EXPERIENCED

Many providers hire someone who says they are experienced but I would encourage you to check into it.  If you go with a service, check the references, if you go with someone inhouse - ditto.  More providers lose money by thinking their person knows what they are doing!

Michele
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