Wiki Optical/ material billing question

[tmitchell]

New to optical billing and currently the organization uses the same NPI/ TIN for all services, (exam and materials) if / when a provider gets denied for non par (materials) the norm is to change the billing provider to one that is known to pay. The logic of this does not sit well with me. Should the optical department be enrolled to have their own TIN/NPI with a provider that would oversee dispensing?

 

[Rpollock623]

I have worked with several practices that share a TIN for the optical and office side. However, I agree with you and I would not be comfortable with switching doctor just for a claim to pay. The patient should be seen by the participating provider so the refraction is finalized by the correct doctor and billing will reflect that.

 

[Cheezum51]

Are all of your provider listed with DMEPOS since you now have to pay an annual fee for them to consider you a participating provider?

Tom Cheezum, O.D., CPC

 

[tmitchell]

Are all of your provider listed with DMEPOS since you now have to pay an annual fee for them to consider you a participating provider?

Tom Cheezum, O.D., CPC

I did read about this, but cannot confirm that the credentialing department has completed this process. Does each provider require enrollment or can their be facility enrollment for materials only?

 

[Cheezum51]

It should be for the facility but you may have to supply all of the provider NPIs who are covered under the registration.

 

[tmitchell]

It should be for the facility but you may have to supply all of the provider NPIs who are covered under the registration.

This answer was my interpretation, thanks for the confirmation. You have been most helpful, thank you.