Guest guest Posted January 28, 2008 Report Share Posted January 28, 2008 Lynn, I’m confused – I’ve been told by supposedly knowledgeable people that you don’t always need a separate NPI for your entity, and recall that was if you were part of a large group – each provider needed a NPI and the practice needed a different one? A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 www.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of Lynn Ho Sent: Saturday, January 26, 2008 4:53 PM To: practiceimprovement1 Subject: RE: More about billing Here is the site where you can apply for your NPI. Fast and relatively easy. https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart You need an individual NPI (just for you!) and a practice or group NPI ( for your business entity if you have one) You need an NPI to bill medicare (I think there deadline is March of this year for using the legacy numbers) as well as most private inusurers (they are slowly switching to a pure NPI system and throwing out the old provider IDS ( also called 'legacy numbers' , (don't worry, it's not like they are going to leave you anything like jewels, etc.)) Lynn To: From: elaine2mdgmail Date: Sat, 26 Jan 2008 13:16:39 -0800 Subject: Re: More about billing I am realizing how green I am to the business. What exactly is an NPI? I thought it was only used to billed medicare. How do I get an NPI. If I opt out of Medicare, then I can't get an NPI? Also if I am non par with Medicare, am I obligated to follow their guidelines ( whatever they might be)? How often can a doctor change their Medicare status? Apologies for all these questions. Am am thinking of a practice where I charge a monthly fee equivalent to my one hour fee. This would include everything for up to 20 half hour visits per year. So the cost per visit can be averaged out and I would give the pt a receipt for the visit based on the average cost. If they get reimbursed they get reimbursed but I really want to stay out of the business of billing insurance companies. Thanx for all the great advice. On 1/26/08, Kenney <rbkthirdcomcast (DOT) net> wrote: IMO, opting out of Medicare does not appear to be good for business. Being non-participating does. Pick and choose the procedures you'll accept Medicare's allowable as payment. If your HMO patients have an out-of-network benefit it may cost them a little more to see you. You'll only need your NPI to bill most insurances soon Using a free service like OfficeAlly or Availity will allow you to bill non-assigned claims to the insurance for your patients. Make sure that your patients check their policies for out-of-network benefits and if only an NPI is needed. Kenney Albuquerque wrote: > Thank you everyone. Your knowledge and experience really helps us > novices who are just getting started. The Medicare opt out form is > something new to me. I am still working on how to structure my fees > but am leaning towards cash only. So next query- > If I am not signed up with any insurance carrier, can pts be > reimbursed for my charges from their private insurance? Or does it > depend on their plan? Anyone know which plans/or types of plans allow > pts to submit? I have a few pts who are asking what insurance I will > be taking. Be nice if I could answer that. > I have been at the same HMO for 15 years, its hard to say good bye to > all these pts that I know so well and have depended on me over the > years. But its time for me to march to my own beat now. > > -- > M.D. > www.elainemd.com <http://www.elainemd.com> > > ---------------------------------------------------------- > > No virus found in this incoming message. > Checked by AVG Free Edition. > Version: 7.5.516 / Virus Database: 269.19.11/1242 - Release Date: 1/24/2008 8:32 PM > -- M.D. www.elainemd.com Helping your favorite cause is as easy as instant messaging. You IM, we give. Learn more. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2008 Report Share Posted January 28, 2008 , My understanding is that if you are the sole proprietor of an LLC you do not need to get an NPI for that LLC. However, if you have another provider that bills, that provider will need their own NPI and then so will the LLC. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Eads Sent: Sunday, January 27, 2008 11:00 PM To: Subject: NPI Lynn, I’m confused – I’ve been told by supposedly knowledgeable people that you don’t always need a separate NPI for your entity, and recall that was if you were part of a large group – each provider needed a NPI and the practice needed a different one? A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 www.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of Lynn Ho Sent: Saturday, January 26, 2008 4:53 PM To: practiceimprovement1 Subject: RE: More about billing Here is the site where you can apply for your NPI. Fast and relatively easy. https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart You need an individual NPI (just for you!) and a practice or group NPI ( for your business entity if you have one) You need an NPI to bill medicare (I think there deadline is March of this year for using the legacy numbers) as well as most private inusurers (they are slowly switching to a pure NPI system and throwing out the old provider IDS ( also called 'legacy numbers' , (don't worry, it's not like they are going to leave you anything like jewels, etc.)) Lynn To: From: elaine2md@... Date: Sat, 26 Jan 2008 13:16:39 -0800 Subject: Re: More about billing I am realizing how green I am to the business. What exactly is an NPI? I thought it was only used to billed medicare. How do I get an NPI. If I opt out of Medicare, then I can't get an NPI? Also if I am non par with Medicare, am I obligated to follow their guidelines ( whatever they might be)? How often can a doctor change their Medicare status? Apologies for all these questions. Am am thinking of a practice where I charge a monthly fee equivalent to my one hour fee. This would include everything for up to 20 half hour visits per year. So the cost per visit can be averaged out and I would give the pt a receipt for the visit based on the average cost. If they get reimbursed they get reimbursed but I really want to stay out of the business of billing insurance companies. Thanx for all the great advice. IMO, opting out of Medicare does not appear to be good for business. Being non-participating does. Pick and choose the procedures you'll accept Medicare's allowable as payment. If your HMO patients have an out-of-network benefit it may cost them a little more to see you. You'll only need your NPI to bill most insurances soon Using a free service like OfficeAlly or Availity will allow you to bill non-assigned claims to the insurance for your patients. Make sure that your patients check their policies for out-of-network benefits and if only an NPI is needed. Kenney Albuquerque wrote: > Thank you everyone. Your knowledge and experience really helps us > novices who are just getting started. The Medicare opt out form is > something new to me. I am still working on how to structure my fees > but am leaning towards cash only. So next query- > If I am not signed up with any insurance carrier, can pts be > reimbursed for my charges from their private insurance? Or does it > depend on their plan? Anyone know which plans/or types of plans allow > pts to submit? I have a few pts who are asking what insurance I will > be taking. Be nice if I could answer that. > I have been at the same HMO for 15 years, its hard to say good bye to > all these pts that I know so well and have depended on me over the > years. But its time for me to march to my own beat now. > > -- > M.D. > www.elainemd.com <http://www.elainemd.com> > > ---------------------------------------------------------- > > No virus found in this incoming message. > Checked by AVG Free Edition. > Version: 7.5.516 / Virus Database: 269.19.11/1242 - Release Date: 1/24/2008 8:32 PM > -- M.D. www.elainemd.com Helping your favorite cause is as easy as instant messaging. You IM, we give. Learn more. Quote Link to comment Share on other sites More sharing options...
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