NPI Numbers > NPI Numbers
Group or Individual NPI
PMRNC:
Your not ignorant at all. Those are all questions you should be asking.
You have to research whether LPC's are recognized in your state, some states don't recognize them ..research "scope of licnese," and your state. As for the structure of your business, I suggest an accountant to advise you. Their are pro's and con's to Incorporating, LLC's, etc.
As for sanctions.. I'm sorry I should have explained. I have worked with various mental health providers who like you have done their fair share of pro-bono, charity and non-profit work. It's great for the soul but when it comes time to get into private practice what I have found is that most providers are not practical nor in the right frame of mind to get ready for the changes they have to make. For example, a patient presents with insurance coverage and either a $10, $20 copay or maybe 50% coinsurance and they don't have the money to pay their portion, it's actually "illegal" to routinely waive or discount the patient's cost-sharing with their carrier. With that said you have to be ready for the adjustment in the way you do business. Developing office policies, procedures, compliance manuals, etc all goes into this before you open your doors and even before you credential with the carriers you choose to credential with. When you begin accepting insurance the game changes .. completely.
My advice would be to find a good practice management consulting team to help set you up, get you educated, credentialed, get your office and policies done, HIPAA compliance, HITECH compliance..etc etc etc.
tsbrown:
Hi Everyone.
Alice and Michele this site is awesome, especially for a newbie.
Linda, I appreciate you so much. GA does recognize and license LPC's. I was licensed by GA Professional Licensing Board. I did some reading and understand more what you mean about change my thinking. In my new book, " The Paper Office," I saw things on balance billing like "if the MCO rejects your claim for payment..., your can only collect the copayment and not the rest", that's scary. You're right, it is illegal not to charge the copay except I have an indigent clause clearly defining indigent and you should heavily document the clients indigence through investigation of the source of income or lack there of and not offer it, but let them ask. I am still confused with your terminology of insurance companies credentialing us? I don't know if insurances reimburse LPC's or if the organization has to be headed by a psychologist. Linda, I have been reading about NPI's but am still a little confused. I can apply for one individually using my ss# and that allows me to work anywhere and bill individually? Or does that have to be associated with an address and business? I have decided to do an LLC for profit but don't have start-up yet because rebounding from a son with cancer. I have a choice to get a group number and attach it to my non-profit "group" since it already exists and switch it over in a few months when I can start the profit? Can the group number switch from a nonprofit to a profit company or is it stationary? I probably will not reach the amount of money for salary that will effect the non-profit in say three months anyway (it's been mostly inactive this year because of the cancer). You can make a certain amount before you have to report or file taxes. Or can I do the indigent counseling under the non-profit and keep the group NPI there, do an individual NPI for my for profit and also use the individual NPI if I do work with for other organizations? Now, I feel like I am starting to know what kind of questions I really need to ask. I am trying to read so I don't feel so lost. I've always said I have a lot of degrees, but the more I learn the more ignorant I get because the more I realize I have to learn. Thanks so much for your attention and help.
PMRNC:
Wait until you decide on your structure of business, practice location, etc before applying for your NPI. Your NPI number must EXACTLY (right down to crossing t's and dotting i's) your Tax record. If there is ANY difference in the two files, claims will get rejected.
Some insurance companies have closed panels and some plain don't credential LPC's, you have to contact the ones you are interested in and they will tell you the credentialing procedure.
Your indigent policy is RIGHT on the money.. your office policy should clearly define indigence and then you document on case by case basis.
tsbrown:
Thank You for This Site!!! The Newbie.
I am a preacher and I want to say I really feel blessed by God to have found this site. Opening a new business is a serious undertaking and there's so many new things to know and do. I find myself obsessed with reading it; things that effect me, things I don't understand "yet", and just hungry for the knowledge that is here. People are real, personalities shine through and the openess and friendliness is astounding. What it has done for me, a newbie, is pushed me to study and learn. Because of this site I spent hours reading, "The Paper Office (especially a very revealing look at games MCO's play in 'Ethical and Legal Issues in Working with Managed Care Organizations')," it's many internet references, other internet sites and this site. Your site is thought provoking, challenging and jam packed with experts and/or people who are willing to share what they have. It stirs my thirst for knowledge and drives me to learn more both on my own and from the site as a soon to be new business owner.
Thanks Sooooooooooo Much.
P.S. Especially you Linda for following through with me.
PMRNC:
You are very welcome! Keep us updated!
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