How to Bill Under a Group Practice?

Many times significant queries are raised about the billing for providers who are working for a group. Here, it is integral to understand not just the difference between the rendering provider NPI and the billing provider NPI, but also how the provider is set up with each and every insurance carrier.

Well, it is not easy enough to put rendering provider’s individual NPI in the rendering provider NPI box, which is the box 24J on the CMS form, and the group NPI in the billing provider information box, box 33a on the CMS form. The individual NPI of provider is linked to the group NPI with each insurance carrier to make the things definite.

It is not just as easy as we think for the provider to be credentialed with the insurance carrier. Their individual NPI must also be linked to the NPI of group if the payment is to be made to the group.

It is essential to ensure that all providers that a group will be billing for are set up rightly with the insurance carriers. Incorrect or wring set up can cause huge issues with the billing and can actually mess up the accounts receivables. Understanding the techniques how the NPI’s work is key.

The rendering provider NPI is believed to be the individual NPI of the provider who conducted the services on the patient being billed. The NPI of the person or entity that should be paid for the services is the “Billing Provider NPI”. In very rare cases, the rendering provider NPI and billing provider NPI are the same. A rendering provider might have several or multiple billing provider NPI’s in some cases. They might have a private practice which has its own NPI and they might work for another group or clinic that has a totally distinctive or different billing NPI. It doesn’t bother at all as long as the insurance carriers have the provider set up righty on their files.

In some cases, if you’re billing for a provider or group, and you’re not sure about the provider’s NPI’s are set up correctly or not, then you should immediately call the insurance carriers to confirm such things in timely manner. It is always better to be safe than to say sorry.

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