Author Topic: NPI's with Clearinghouses  (Read 1089 times)

DPlace

  • Newbie
  • *
  • Posts: 4
NPI's with Clearinghouses
« on: February 17, 2022, 07:10:46 PM »
I am wondering if it is normal to only be able to set up ONE NPI with a clearinghouse? the EMR system we are using only allows us to set up either the Individual NPI or the Group NPI; but not both. I also have multiple providers that I would needing be billed out on their own and the EMR system only allows one NPI set up.

Is this something that is typical with EMR systems and Clearinghouses?

Thank you

kristin

  • Hero Member
  • *****
  • Posts: 703
Re: NPI's with Clearinghouses
« Reply #1 on: February 18, 2022, 12:29:14 AM »
You don't say which EMR/Clearinghouse you are dealing with, so I will have to base my answer on what I know from my experience.

When I am setting up providers through a clearinghouse, if it is a group practice with multiple docs, I do everything through the group NPI, because all providers have already "assigned benefits" to the group practice.

If it is a solo practice, with no group NPI for some reason, I set it up for the solo doc, using their NPI. But this is rare, as most solo docs also have a "practice" as they are incorporated in some fashion, with a Tax ID and a group NPI.

It may be that the EMR/clearinghouse you are using requires you to set up multiple accounts, based on if there is a group NPI, or just an individual NPI.

I hope that helps in some way!

RichardP

  • Hero Member
  • *****
  • Posts: 757
Re: NPI's with Clearinghouses
« Reply #2 on: February 18, 2022, 02:43:07 AM »
DPlace - consider the reason why the NPIs exist  (apologies if you already know this)

- NPI Type 1 identifies who did the work
- NPI Type 2 identifies who gets paid

The Clearinghouse does not care who did the work.  They want to know who gets paid.  That would be the NPI Type 2.

Again - Type 1 (who did the work) and Type 2 (who gets paid) NPI numbers.  Both must be used on the CMS 1500 form that is submitted to Medicare.  One tells CMS who did the work, and the other tells CMS who gets paid.  In the case of a solo practitioner, both of the NPI numbers provided on the CMS 1500 form belong to him.  In the case where the work was actually performed by a hireling, the CMS 1500 form must contain the Type 1 NPI number for who did the work (the hireling), plus the Type 2 NPI number for who gets paid (the hirer / owner).

On the CMS 1500 Form, the Type 2 NPI number for who gets paid goes in Box 33.  The Type 1 NPI number for who did the work goes in Box 24J.  The Type 1 NPI number for the referring doctor goes in Box 17a.  This is how we do it and we have no problems getting paid.

(If you have never billed on paper, then reference to the CMS 1500 Form may seem odd to you.  But the fields on the paper form have their equivalent in the electronic record that gets created when you bill electronically.)

Having said all of that, an EMR is not a billing software.  So you should consider whether you are confusing two pieces of software.  Many EMRs don't have a billing function.   You need a separate Practice Management (billing) software for that.

The EMR may only want the "who gets paid" NPI number, because that identifies who owns the business.  But the billing software needs both the Type 1 (who does the work) and Type 2 (who gets paid) NPI numbers - for the reasons stated above.

There are a number of threads in this blog that deal with this issue.  You might read through this link, which I quoted from above, to see if it clarifies anything for you.

https://www.medicalbillinglive.com/members/index.php?topic=7045.msg21031#msg21031
« Last Edit: February 18, 2022, 02:46:48 AM by RichardP »

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: NPI's with Clearinghouses
« Reply #3 on: February 22, 2022, 09:40:31 AM »
I have a provider who has been set up for over 20 years and doesn't want to change anything.  He's set up with some companies under a group NPI and EIN.  Other companies with his individual NPI and EIN, and still others (I just found out yesterday - after 7 months) under his SSN and individual NPI so I have him in my clearinghouse under all 3 combos.

What clearinghouse is it?
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

RichardP

  • Hero Member
  • *****
  • Posts: 757
Re: NPI's with Clearinghouses
« Reply #4 on: February 22, 2022, 05:25:05 PM »
the EMR system only allows one NPI set up.

I just caught this phrase.

This is most likely a political requirement, not a medical one.

That is, the EMR is forcing each provider to pay a fee for access to the EMR.  Each provider must have (and pay for) their own version of that EMR.

It sounds like that is what you are bumping up against.

MaxeeleeCol

  • Newbie
  • *
  • Posts: 10
    • Healthcare
Re: NPI's with Clearinghouses
« Reply #5 on: February 22, 2022, 06:39:42 PM »
According to my research, Individual providers can only have 1 NPI whereas an organization can have 1 or more than one NPIs. This is probably the reason that EMR system allows only one NPI integration.

RichardP

  • Hero Member
  • *****
  • Posts: 757
Re: NPI's with Clearinghouses
« Reply #6 on: February 23, 2022, 03:35:43 AM »
Max - whether individual or organization, the distinction between who did the work and who gets paid still holds.  If an EMR does not have a billing module incorporated into it, as many don't, it will only be concerned with who owns the business / who gets paid.  They will not be concerned with who did the work.

As I stated above, billing software needs to forward the NPI # for who did the work and who gets paid - so it needs both.  The EMR software (without a billing module) only needs to know who owns the business / who gets paid.  So it only needs one NPI #.

But if the EMR license is sold as only one provider per instance of the EMR, then it will will only have space for the NPI number of the owner of that license.

MaxeeleeCol

  • Newbie
  • *
  • Posts: 10
    • Healthcare
Re: NPI's with Clearinghouses
« Reply #7 on: February 23, 2022, 11:05:10 AM »
I see, thanks so much for the info. I'm doing my research, will ask here if find anything troubling.

RichardP

  • Hero Member
  • *****
  • Posts: 757
Re: NPI's with Clearinghouses
« Reply #8 on: February 24, 2022, 02:51:00 AM »

MaxeeleeCol

  • Newbie
  • *
  • Posts: 10
    • Healthcare
Re: NPI's with Clearinghouses
« Reply #9 on: February 24, 2022, 01:11:03 PM »
Rich, I've read it. Thanks for sharing.