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Billing / Management questions

  1. #1
    Question Billing / Management questions
    Medical Coding Books
    I could really use some feedback/ideas regarding billing as individual vs group and with multiple locations. We are a group practice and we have multiple physicians who are all hospital based. We provide services at multiple hospitals in 2 states. Some of our doctors provide services in BOTH states, but most practice in one state or the other. Right now we have 1 group name, 1 NPI and 1 tax ID #.

    Basically I have 3 questions. 1. Since we are a group -- and the physicians are employed by the group, are we REQUIRED to submit claims as a group .. and bill each doctor as the rendering provider.. or can we bill some plans as individual physicians? I'm thinking it HAS to be billed as a group... but I'd like to know if the other option is ok.

    2nd: Right now we have 3 separate hospitals where we provide services. 2 hospitals in the same city and another in a different state. What are the benefits/drawbacks of having multiple NPI numbers for the group?? (I know each DOCTOR can only have 1 NPI, but groups can have more). What about the TAX ID? would it need to be different??

    3rd: I'm having difficulty with one of my plans at the moment regarding contracting. They are saying we need separate contracts for each location (hospital)? It's a medicaid plan that still assigns a unique medicaid provider number for each service location. Does anyone else have doctors that see patients at several hospitals? Do you have to have a different contract or ID number for each hospital? I can understand if you have multiple offices, but at every hospital? We put the hospital name, address and NPI in box 32 of the HCFA, so I thought that would be enough. Maybe not??

    I would really appreciate any ideas/ thoughts or feedback on any of these 3 questions.

  2. #2
    If you are a group billing under the same tax ID number then you will use the provider's NPI numbers only to indicate the rendering provider on box 24J, the pay to address and NPI number would be for the group.
    I don't understand why you would need separate NPI numbers for your providers for each hospital, you do need however, to put the hospital's NPI number in the place of service field on your CMS1500. Hope this helps.

  3. Default
    For 96100, a code use for psych tests in workers comp, has it been deleted? Thanks

  4. #4
    Default Billing / Mgmt Questions
    We have 6 providers working in four hospitals, and were advised by our local Medicare contractor that we would need a different NPI for each location. Our insurance contracts have also been affected because one hospital is not contracted with a major payer that the other hospitals ARE contracted with. It has caused a few glitches and needs to monitored (insurance credentialing contracts being mailed to wrong addresses....etc.). We are all in one state. When it was two hospitals, we were not advised to do that, but now that we have credentialed providers for other hospitals, NPI numbers are being added. Hope that info helps.

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