Author Topic: Sole proprietor with 2 Dr's working under him  (Read 2210 times)

wildcat1842

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Sole proprietor with 2 Dr's working under him
« on: September 29, 2015, 09:55:27 PM »
My boss (dr) is a sole proprietor that has two doctors that work for him, they have both re-assagnied their Medicare benefits to my boss so that Medicare pays my boss, then my boss pays the two dr's. They are independent contractors. So I need help figuring out whose NPI goes in which box.

We just switched clearinghouses. I use Medisoft, and their tech support told me I should be billing with a group NPI number(I've been billing with just the main dr's NPI#). They told me I needed a new PTAN number from Medicare that's associated with this group NPI. They told me this before I knew that the other two dr's had reassigned their benefits to the main dr. Can anyone explain to me what I need to do and where I need to put all the different NPI's? Thanks!

RichardP

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Re: Sole proprietor with 2 Dr's working under him
« Reply #1 on: September 30, 2015, 01:49:34 AM »
Type 2 NPI Number - who gets paid - goes in Box 33a on the CMS 1500 Form.
(This would be the number of the sole proprietor - he is the billing entity.)

Type 1 NPI Number - who did the work - goes in Box 24J on the CMS 1500 Form for Medicare claims. (This would be the number of whoever did the work.)

One of our clients is set up exactly like this.  This is how we bill.  This gets our client paid.  None of the commercial carriers in California require the Type 1 NPI Number in Box 24J - but your mileage will vary, depending on what the commercial carriers in your state want.

Read the bottom of Page 4 and the top of Page 5 of the first pdf file linked below.  That should help you sort out if being advised that you should be billing with a group NPI number means your sole proprietor does not have a Type 2 NPI Number.  It might be good to get a heads up from a health care attorney in your state on this issue if your client doesn't have a Type 2 NPI Number.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/NPIBooklet.pdf

This pdf file is worded a bit differently, but is basically the same as the first link.
http://www.dhcs.ca.gov/services/MH/Documents/ProviderFile/NPIBooklet.pdf

wildcat1842

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Re: Sole proprietor with 2 Dr's working under him
« Reply #2 on: September 30, 2015, 06:54:42 AM »
Thank you Richard! So I should still be using the main Dr's individual NPI in box 33A, and the other physician's NPI (who saw the patient) in box 24J?

Do you use Medisoft by chance? I used to have it set up like I mentioned above, but tech support changed things and now I'm not sure how to get the other Dr's NPI to show in box 24J. Thanks!

Michele

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Re: Sole proprietor with 2 Dr's working under him
« Reply #3 on: September 30, 2015, 09:31:07 AM »
If the main Dr is set up with insurances to receive payments under his individual NPI then yes, you would use that in box 33A.  And the physician who saw the patient, put his individual NPI in 24J. 
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wildcat1842

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Re: Sole proprietor with 2 Dr's working under him
« Reply #4 on: September 30, 2015, 10:15:57 AM »
Thank you Michele! :)

RichardP

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Re: Sole proprietor with 2 Dr's working under him
« Reply #5 on: September 30, 2015, 10:50:49 AM »
In re-reading my response, I realize I was not as straightforward as I could have been.  I used your term sole proprietor in my response only because that is the term you used.  Note that Medicare distinguishes between sole proprietor and solo practitioner when it comes to NPI Numbers.  I was questioning if maybe the Medisoft Tech Support had some reason to know that your client is actually a practitioner.  If he is, that would require an answer different than if he indeed is a proprietor (folks sometimes don't know that Medicare sees a difference between those two terms).

Do you know for certain how Medicare has your client set up - proprietor or practitioner?  If your client has not established a legal entity through which to do business (corporation, partnership, LLC, etc.), he should be set up with Medicare as a proprietor, not practitioner.

If you already know this, then nevermind.
« Last Edit: September 30, 2015, 10:56:53 AM by RichardP »

wildcat1842

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Re: Sole proprietor with 2 Dr's working under him
« Reply #6 on: October 01, 2015, 08:51:33 AM »
Thank you Richard. I called Medicare and made sure I was billing it correctly. They told me the other 2 dr's NPI numbers were tied to my boss's, therefore his NPI will go in box 33A, and their NPI will go in box 24J. Thanks again!
« Last Edit: October 07, 2015, 01:13:45 PM by wildcat1842 »

RichardP

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Re: Sole proprietor with 2 Dr's working under him
« Reply #7 on: October 01, 2015, 10:09:37 AM »
You're welcome.  Glad you got it sorted out.