Billing > Billing

Chiro billing in MD/DO offices?

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PMRNC:

--- 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?   
--- End quote ---

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?
--- End quote ---

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

lotus921v:
Can you be credentialed with say 15-20 diff groups?

QueenAlicia:
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:
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).

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