Wiki Bringing Associate Dr. into our practice

[shastadazy]

Ok, so I'm trying to get my ducks in a row here and I've never had to do all of this..

We are bringing an associate chiropractor into our chiropractic office and I'm trying to make lists of all of the various things I need to get in order, but I'm not sure where to begin. We have a "group practice" but until now we've only had one provider, the owner. So I have a few questions, if anyone can give me any sense of direction! ;-)

The new Dr. already has an individual NPI, and we already have the group NPI. Do we just need to "update" the group to include the new Dr. as an individual under our group umbrella?

We have a tax ID for the corporation. Is he automatically included under that and could, potentially, bill out under it, or do I need to somehow update those records to attach him to that ID as well??

Will I need to apply to Medicare for him as an individual, or is he automatically included under our Group PTAN?? Our original Dr. initially billed under his SSN and as individual, but eventually everything was transitioned to the GROUP dynamic, but since it was just him anyway, we were still "covered" if we billed as Individual or as Group. This new Dr. isn't par w/ any insurances(including Medicare) yet. So.... does that mean we can't bill out under him until that goes through, or is he covered by the existing group info??

Similarly to the above.. will I need to get him individual IDs under the various insurances or just add him to those "group" ideas.. or is that going to be specific to the insurances and something I just need to inquire of them?

I have no frame of reference for any of this, so anything anyone can tell me to enlighten me will be helpful and much appreciated, as it will give me somewhere to start

Thanks in advance!

-Denise L. Laudenberger, CPC, CCPC

 

[AmandaBriggs]

I don't have much experience with this either, but I do know that when new providers join our practice we have to get them credentialed with each payer before they can submit charges to insurance.

 

[shastadazy]

re: New assoc. dr.

Ok.. so I have some of the info. Thought I'd update here, in case it helps anyone else - OR in case anyone else has further info to help me!

The new associate Dr. has his own individual NPI and we already have our existing Type 2(organizational) NPI, so I just made sure all of the info on both is current.

Had to get him into CAQH.org for credentialing, because apparently "everyone" refers to that now! Got all of his data entered and attested, so he's good to go there.

We called every insurance that we participate with and explained that we have this new Dr. and he doesn't participate w/ anything yet, and what do you need from us in order for us to be able to bill out on his behalf, under our group? They've sent us links and forms, so it's definitely dependent on the insur., but most asked us to be sure his info is correct in CAQH first..

Medicare has instructed us to fill out form 855I(for him as an individual) and form 855R(to update our existing group w/ Medicare to "include" him.

We can't bill out under any of these insurances, on his behalf, until they've completed their specific process and have approved/credentialed him for each insurance.

My next question........ Can we bill out under New Dr. in the meantime using our existing Dr.'s information, as the "supervising physician" ? If so, what are the stipulations there? For instance, does the supervising physician have to be present at the time of service, etc.?

Thanks in advance for any enlightenment!