Author Topic: Chiro billing in MD/DO offices?  (Read 2119 times)

lotus921v

  • Newbie
  • *
  • Posts: 8
Chiro billing in MD/DO offices?
« on: September 29, 2012, 12:10:53 AM »
As a chiro, I am looking at doing some daily contract work in MD offices.  I am not in network with any insurance companies, and am looking to have them bill out using my NPI number and keep the receivables while giving me a flat daily rate.  How on earth does this work?  Is there a way for them to use their in network status and bill out for my services?  Any help would be hugely appreciated as I have never done any of my own billing!

PMRNC

  • Hero Member
  • *****
  • Posts: 4218
    • One Stop Resources & Networking for Medical Billers
Re: Chiro billing in MD/DO offices?
« Reply #1 on: September 29, 2012, 04:18:13 PM »
Not a straight forward answer as it depends on your legal arrangement with the group. I can tell you that you will need to be credentialed with the carriers in order to get paid at the par rate.   Again, there are more things to consider but it all depends on your legal structure within the group.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

lotus921v

  • Newbie
  • *
  • Posts: 8
Re: Chiro billing in MD/DO offices?
« Reply #2 on: September 29, 2012, 07:55:28 PM »
I was leaning towards being contracted as an independent contractor.  Can they bill out using their npi numbers?  Or if they use my npi, does that mean they can get paid the out of network rate?  I also am planning on using this similar arrangement at multiple MD offices, so in your experience, is that going to start becoming a problem?  What would you suggest?

PMRNC

  • Hero Member
  • *****
  • Posts: 4218
    • One Stop Resources & Networking for Medical Billers
Re: Chiro billing in MD/DO offices?
« Reply #3 on: September 30, 2012, 10:00:58 AM »
No matter what you will need to have your own NPI and bill with your own NPI and you will also have to be credentialed with any insurance companies in order to service at par rates. That's a given no matter what.  I would suggest talking to your attorney for the business relationship issues, there are a lot of legal factors to consider.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

lotus921v

  • Newbie
  • *
  • Posts: 8
Re: Chiro billing in MD/DO offices?
« Reply #4 on: September 30, 2012, 12:48:28 PM »
Sounds good.  I appreciate the advice.  I will def consult with my attorney.  It helps if I have specific questions to ask him so he racks up less of his hourly rate.  Last questions for now.  If i am out of network, the practice is in network, we bill using my npi number, does that mean that we are 1. restricted to patients with out of network benefits? and 2. Get to bill higher out of network rates?   

Side question, i know groups have group npi numbers.  When are those used?

Thanks so much!

PMRNC

  • Hero Member
  • *****
  • Posts: 4218
    • One Stop Resources & Networking for Medical Billers
Re: Chiro billing in MD/DO offices?
« Reply #5 on: September 30, 2012, 12:57:32 PM »
Quote
  If i am out of network, the practice is in network, we bill using my npi number, does that mean that we are 1. restricted to patients with out of network benefits? and 2. Get to bill higher out of network rates?   

Carriers each have their own credentialing requirements.. Generally speaking the physician rendering services would need to PAR with that carrier in order to receive par benefits.  The provider in that group can still see the patient but it gets really sticky if they don't advise the patient of the out of network status of the provider. This happens a LOT in the ER.. the hospital will be participating and the physician group is not, makes for some angry patient's and a right to appeal.  How you setup with this group will depend on how you credential. MORE than likely they will have all the information for you and adding a physician to the credentialing pot is not so difficult. (but again.. it's going to depend on your financial and legal relationship with them)

Quote
Side question, i know groups have group npi numbers.  When are those used?

I really like this article to explain NPI  (group vs. Individual) 
http://www.aafp.org/online/en/home/practicemgt/specialtopics/regulatory-compliance/hipaa/natlproviderid/npisolopractice.html
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

lotus921v

  • Newbie
  • *
  • Posts: 8
Re: Chiro billing in MD/DO offices?
« Reply #6 on: September 30, 2012, 02:42:03 PM »
Can you be credentialed with say 15-20 diff groups?

QueenAlicia

  • Sr. Member
  • ****
  • Posts: 347
Re: Chiro billing in MD/DO offices?
« Reply #7 on: October 01, 2012, 04:29:23 PM »
From what I was told you can be a provider that belongs to multiple groups.  I have seen providers work for several different clinics/groups/hospitals. They have their own individual NPI number and when they perform services it is billed for the group in which they performed the services for.  All of this should be added to their CAQH.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4708
    • Solutions Medical Billing
Re: Chiro billing in MD/DO offices?
« Reply #8 on: October 03, 2012, 06:33:18 AM »
And if you work for an MD group, then they will bill using their group NPI for the billing information and your individual NPI as the rendering provider.  Any services provided by you must show your individual NPI as the rendering provider.  Your services cannot be billed out under someone else's NPI (as rendering).
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