General Category > General Questions
Adding NP!!!
RichardP:
--- Quote from: Misil on February 08, 2014, 09:14:23 PM ---A real, live person owns the group PC, and wants to hire the NP to work under him.
--- End quote ---
Yes. Real, live people usually are the ones who own Groups. But Groups (properly formed) are legal entities that can conduct business in their own name. A (properly formed) Medical Group must be the billing entity and must have its own Type 2 NPI Number (who gets paid). So:
1. Who is doing the hiring? The Group (a legal entity) or the real live person?
2. Who will bill for the NP's work? The Group (a legal entity), using their Type 2 NPI Number, or the real live person, using his Type 2 NPI Number?
3. Who will pay the NP? The Group (a legal entity), or the real live person?
The answers you seek depend upon a correct answer to these three questions. Every time you answer, you throw in something that makes your answer unclear.
... can this NP also provide ob/gyn procedures and bill?
The NP can be paid for providing OB/GYN procedures only if his Taxonomy Number allows him to. And if the NP is hired by the Group, he cannot bill for his own services. The Group is the billing entity, so it will bill for the NP's services and pay him a salary.
PMRNC:
--- Quote ---Yes. Real, live people usually are the ones who own Groups.
--- End quote ---
LMAO... what about the Zombies?
Michele:
Misil,
I don't like to assume but for sanity's sake I'm going to assume the following:
There is a doctor (live) that owns a group that wants to hire an NP to work in the group. The group would get the payments.
Assuming the above statement to be describing your situation here are some answers to your questions:
--- Quote from: Misil on February 08, 2014, 02:57:32 PM ---Yes, there's a doctor's group with a group npi number, that wants to hire a NP to work under him/her.
1. For Medicare, do I have to fill out 855R?
--- End quote ---
You would not only have to fill out the 855R but since the NP is new and is not credentialed with any insurance carriers you also need to complete the CMS 855I.
--- Quote from: Misil on February 08, 2014, 02:57:32 PM ---For commercial insurances,
1. what if the doctor has individual provider numbers instead of group provider numbers?
--- End quote ---
If the doctor wants to have the NP work under the group, then the group should be established with ALL insurance carriers. If the group is only established with some and the dr bills individually under others that is going to be a billing nightmare. But I guess technically the NP could be set up under the dr with those companies. Personally I would not do it that way and I would tell the dr why.
--- Quote from: Misil on February 08, 2014, 02:57:32 PM ---2. Do I have to apply for group provider numbers, then add the np under that group provider numbers?
--- End quote ---
You have to contact each insurance carrier to see what they require to add the NP.
--- Quote from: Misil on February 08, 2014, 02:57:32 PM ---3. Does the np have to use group npi or his/her individual npi #?
--- End quote ---
The NP would use his/her individual NPI as the rendering provider on any services performed by them.
I hope this helps. Your information was rather confusing.
Misil:
Michele, yes, your assumption is right.
There is a doctor (live) that owns a group that wants to hire an NP to work in the group. The group would get the payments, then will pay the NP.
You said, You would not only have to fill out the 855R but since the NP is new and is not credentialed with any insurance carriers you also need to complete the CMS 855I.""
Does the NP have to complete 855I even though the claims will be billed using group ID #?
RichardP:
--- Quote from: Misil on February 10, 2014, 02:58:43 PM ---There is a doctor (live) that owns a group that wants to hire an NP to work in the group. The group would get the payments, then will pay the NP.
--- End quote ---
For a Group to meet the CMS definition of "Group", and therefore be considered legal for billing purposes, it must meet at least the following requirements:
1. Be an actual Group. That is, it is owned by more than one physician.
2. Be a legally-constituted entity, with its own Taxpayer ID Number and Type 2 NPI Number and designated officers who conduct business in the name of the Group.
3. Reimbursement criteria must be laid out in writing and a copy submitted to CMS. Reimbursement must be based on pre-defined criteria. No one can be paid based on their productivity (e.g., the more patients you see, the higher your pay).
I researched this extensively about 6 years ago and have copious notes and print-outs from CMS somewhere. I can't take the time to find them at the moment, so I'm operating from memory.
I don't remember that a single practitioner can be the sole owner of a "Group". But I am willing to be corrected if the truth is different.
The reason I'm making an issue of this is because, if this is actually a single practitioner, rather than a legitimate Group, the practitioner has the option of the NP billing in the name of the practioner - which will generate a higher reimbursement and the NP does not need to have an NPI Number (the supervising physician's Type 1 NPI Number would go in Box 24J for Medicare work). The NP would also not need an OB/Gyn Taxonomy number if the supervising physician had one. If working for a practitioner, the NP can also bill in their own name, but for that they would need their own NPI Number, OB/Byn Taxonomy number, and the reimbursement rate is lower.
http://www.apapracticecentral.org/news/2008/group-practice.pdf
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