Author Topic: NEED NPI GROUP # HELP ASAP  (Read 2261 times)

ellie

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NEED NPI GROUP # HELP ASAP
« on: April 27, 2013, 06:53:46 PM »


We are a Ambulatory Surgery Center.

We have about 4 physicians who do procedures at our facility,  they now are owned by a Hospital, prior they used their own NPI #

Do we still use the Rendering physicians individual NPI # now or do we have to use the Hospital's NPI since they

now work for them ??????????

Medicare is questioning this.  Prior claims were the rendering physicians individual NPI # and the Facility is the Billing provider.........

Not sure how about the renderng and billing provider.

Need answer ASAP.

Thankyou !

RichardP

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Re: NEED NPI GROUP # HELP ASAP
« Reply #1 on: April 28, 2013, 04:32:27 AM »
An organization can get paid, but an organization cannot do work.  Only people can do work.  Therefore, it would be an odd situation where an orgnization is considered the rendering provider.  The common setup for NPI Numbers on the CMS 1500 Form is this:

Rendering Provider (who did the work) in Box 24J
Billing Provider (who gets paid) in Box 33a
Referring Provider (if any) in Box 17.

In your case, I assume it is the ASC that gets paid, so their Type 2 NPI Number would go in Box 33a.  The Type 1 NPI Number of the one who actually did the work goes in Box 24J.

ellie

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Re: NEED NPI GROUP # HELP ASAP
« Reply #2 on: April 28, 2013, 08:56:50 AM »
On our Claim we have the ASC NPI as the rendering, and the ASC in Box 33a Billing provider. Referring in box 17.  Type ( 2 ) NPI ? 

RichardP

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Re: NEED NPI GROUP # HELP ASAP
« Reply #3 on: April 28, 2013, 03:32:36 PM »
Based on your response, your setup appears to be as follows, but you don't specify the NPI Number Type.  Are you getting paid with this setup?

Box 24J  = Rendering Provider (who did the work?) = ASC NPI  (Type 1 or Type 2?)
Box 33a = Billing Provider (who gets paid?) = ASC (Type 1 or Type 2?)
Box 17   = Referring Provider (person who referred) = who? (Type 2)

Note that for NPI Numbers:

 * Type 1 = who did the work (a person)
 * Type 2 = who gets paid (a legal entity such as an incorporated provider or an organization)

Box 24J wants to know who did the work (a person; Type 1)
Box 33a wants to know who gets paid (an incorporated provider or organization; Type 2)
Box 17 wants to know who referred, if anyone (a person; Type 1)

Remember that an organizatiton is a legal entity that can get paid, but it cannot do work.  Only real people can do work.

ellie

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Re: NEED NPI GROUP # HELP ASAP
« Reply #4 on: April 28, 2013, 05:37:27 PM »
I noticed that the Rendering and & billing on one of our claims is both the ASC. Evidently the Coder did something wrong, possible did not click on the right claim format  ????

ellie

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Re: NEED NPI GROUP # HELP ASAP
« Reply #5 on: April 28, 2013, 05:42:53 PM »
24J physician NPI    Type 1
33a ASC NPI           Type 2
17 Referring Physician NPI number  Type 1.  Alot of times the 24J physician is also the referring physician for the ASC. 

She kept asking me who the CRNA is. I think she was looking at either anesthesia bill and/or physicians bill, but also noticing our mistake on claim ? That is what I am guessing.