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bill2doc

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Hi All,

I have been hired to do set up, billing/coding for a General Surgery group. my understanding is that most of the surgery's will take place at the hospital, kind of like their own surgery center. I have no clue how to set up a group as far as NPI's PTAN's and Tax ID's and I'm confused on how my HCFA 1500 should look as a group. I have only billed for professional services for individual providers....Can someone educate me on this please !!!!

Desperate need of help !
 
My advice is to contact your payer reps. The way you credential them as a group practice will impact how you bill for them.

A hospital is not a surgery center, so you'll have to make sure that you use the correct POS based on patient status (inpatient or same-day). Do they have priveleges yet?

Your software people can help you with making sure that your numbers are loaded into the correct places behind the scenes, so that you drop the billing/NPI/TINs in the right places. It varies based on how you have set up your software (as a practice vs. as a billing system for a group of individual providers).

I'm not sure this answered your question, but I know billing issues can stem from improper credentialling and software setup.
 
First you will want to know if the providers are employees of the surgical practice. If they work as employees then the TIN of the group is what you will use. The group may also have other provider identification numbers that have been set up under the group name. And of course each individual provider will have his own NPI number, and the group would also have it's own NPI number. There are carriers like Aetna who assign each provider with an individual provider number which will need to be plugged in also.

This provider numbers will be found in their contracts with Medicare , Railroad Medicare P Medicaid, BCBS and other carriers. These carriers will assign provider numbers according to the status the providers signed up (self employed or employee).

If this is a new group you will need to complete applications to your carriers (most can be done online, but there are stipulations about who can complete the applications). Check with your local State Secretary of State to find out if the group has a TIN for the group.

When you have all the correct TINs and other provider numbers your vendor will help you set up your billing software.

This is pretty sketchy but maybe it will help.
 
The group of new physicians are moving in with my physician and while my current doc is staying completely separate, these others want to come in as a group. I'm so confused on how that all works mostly how the end of year W2's come in a how they files taxes. They say they want to be individual doc's but they want to use a group name (blah blah surgical group) I don't think they can use a group name and be completely independent of each other....can they. Is anyone billing for a group that would be willing to talk with me. E-mail, phone...I don't care. I'll send you a starbucks gift card for your help hee hee :)
 
By the way...can they be individual providers/sole proprietors but create a fict business name and order cards and letterhead with the group name but still be individual sole proprietors ???
 
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