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Same Tax ID/ Different NPI

  1. #1
    Question Same Tax ID/ Different NPI
    Medical Coding Books
    I work for a group of Doctors that are under the same tax id, but they each have a different group NPI. My question is If you have two physicians with the same Tax Id, different taxonomy and different NPI see the same patient, same day, same DX, would you be reimbursed by insurance? I know Medicare states" that physicians in the same group but different specialties may bill and be paid without regard for being in the same group", but are they talking about same Tax ID, different NPI?

  2. #2
    Lauderdale Lakes
    If they are different specialty's then yes you can bill for two office visits. The only problem would be the dx. Usually different specialty's have different dx. One of them might get denied from the insurance company. You would then just call the insurance to let them know that this was two different specialty's. If they dont reprocess the claim over the phone then you would have to appeal it.

  3. #3
    The Doctors are both Oncologist. One is a Radiology Oncologist and the other is a Medical Oncologist. Would the insurance companies look at this being different specialities since one is radiology and one is medical oncology or would they look at this as the same specialty?
    Last edited by bcarruth; 06-13-2011 at 12:49 PM. Reason: Added a question

  4. #4
    Lauderdale Lakes
    That I am not sure. I would assume it would be different specialty's but I dont want to say for sure. You might want to call the insurance and speak with your provider rep and find out for sure.

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