Author Topic: Appropriate NPI and taxonomy for Cardiologist Grp practice billing Physiotherapy  (Read 3256 times)

drdrew3

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We are forming a new Med Group practice, structured as a Corporation to provide billing and render services/therapy for patients. we will be leasing space in an existing Cardiology private practice as a separate Corporation.

Our Group will be hiring some of these Cardiologists as W-2 employees because these MDs would like to provide ancillary services such as Physiotherapy.  the new group will deal mostly with PPO private insurance, not medicare, as we will be billing services under our group as OUT of Network.

my questions are:
1) what NPI and taxonomy would I use to register this group under if we are using MDs as Cardiologists, yet providing non-cardiovascular ancillary services such as Physiotherapy?

2) although these MDs are Cardiologists, would there be an issue of reimbursments due to their specialty not being the same as say a Physiatrist or Physical Therapist when we send in claims for Physical Medicine/Therapy?

3)our Group practice will NOT be contracted with any insurance as to capture OUT of Network benefits only. If these cardiologists are already IN Network in their own Group practices and possibly as individual providers, HOW would that affect the claims if these MDs are hired under our Group practice as being OUT of Network?     
.....Although I know the answer to this for a Physical Therapist, after speaking with BCBS reps, they said it doesnt matter if the PT is in or out of network working at other facilities, they reimburse based on the status of the billing group being IN or OUT of network...so does this apply for the MDs in our case as well?

thanks for any help!

Michele

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1.  You would apply for a type II, group NPI and list it as a multi-specialty group with more than one taxonomy.  Then select as many taxonomies as needed to cover the services you will be rendering.

2.  That will depend on the insurance carriers and what services they allow the cardiologist to bill for.  If they consider it in their "scope of practice" then they will cover it.

3.  Again it will depend on the insurance carrier.  When you are billing under the group name, NPI & EIN they SHOULD pick them up as OON or Non Par, even if they are par individually or as part of another group.  However, some insurance carriers may pick up the PAR status and process the claim that way.
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