Switching provider from SSN to EIN

[QueenAlicia]

I have a provider who needs to switch her billing from out of her personal SSN to her corporation EIN.  I know this requires filling out paper work and her current biller has no clue on how to do this.  What forms need to be resubmitted with her new EIN#? How fast will the EIN go into affect?  I know it probably isn't as easy as calling up and talking to someone ( nothing is never that easy in this industry). 

[PMRNC]

You must notify all insurance carriers using the required method of each insurance carrier. (usually a 1099 but you will want to call each of them first)
 When changing tax ID information, many commercial carriers require that new contracts be signed. Even though the provider may have been in network with an insurance carrier for years, when switching to an EIN# it is as if it is an entirely new provider. Medicare requires that the appropriate CMS forms be completed.

Also your provider will need to obtain a group or type II NPI number that MUST coorespond with the tax ID number and business name! The provider keeps the individual or type I NPI to identify themselves as rendering provider but will use the Type II NPI for billing.   

IMPORTANT:  An individual or Type I NPI cannot be used with an EIN# and a legal business name.

 

[QueenAlicia]

Thanks Linda!

At this time should she try to negotiate the fees?

[dekenn]

Actually, an individual NPI number is appropriate for a sole proprietor, even if he has a tax id (EIN) and a DBA name.
The key is not the Employer ID number, everyone needs that to pay payroll taxes, etc., but that he's a sole proprietor, not an LLC, or incorporated in any way, or in a group practice.

[QueenAlicia]

She's incorporated now.

[PMRNC]

Actually, an individual NPI number is appropriate for a sole proprietor, even if he has a tax id (EIN) and a DBA name.
The key is not the Employer ID number, everyone needs that to pay payroll taxes, etc., but that he's a sole proprietor, not an LLC, or incorporated in any way, or in a group practice.

Yeah she said corporate EIN.   And regardless..yes with NPI's the important part is the EIN it all has to match with NPI

[QueenAlicia]

So basically fees can be negotiated with the insurance carriers at this time?

[PMRNC]

So basically fees can be negotiated with the insurance carriers at this time?

Well, it's not quite that easy, some carrier's negotiate and some don't. If you have never done them you will want to make sure the provider has their attorney on hand to go through contracts if negotiating fee schedules. There's a lot of work that goes into negotiating for the provider.

[QueenAlicia]

I think she may want to negotiate fees with certain carriers.  Out here in CA there is a plan called Value Options Partners/payers (mind just went blank) and they barely pay for visits so she was saying maybe try and see of they could pay out more.  I think she is okay with the other fees.  I will be discussing this more with her but she's been really busy and only has time on the weekends.

[PMRNC]

There are all sorts of negotiations, but fee schedule's are not always negotiated just because a payer pays too low.. MANY carriers will only negotiate if there is a very low amount of providers per geographical location, and then also they won't negotiate by throwing out a number, a certain amount of homework has to be done to determine the level of negotiation's per CPT code. After all that the contract has to be negotiated to reflect the agreed upon fee schedule.  MAKE sure an attorney IS on her staff or available to review and sign off on any/all negotiations, trust me I've seen doctors get screwed when they don't have the contracts gone over by an attorney or someone experienced to catch these things and the first person they are going to blame is whomever negotiated.  I did straightforward credentialing for about 10 years before I even ventured into negotiations.