Loading ...
Sorry, an error occurred while loading the content.
 

Re: [CRN-L] NPI Stories

Expand Messages
  • kampsene@aol.com
    SO, LET ME GET THIS STRAIGHT.....WE ARE A SOLE PRACTICIONER WITH AN INDIVIDUAL # AND A GROUP #.....I AM USING THE INDIVIDUAL # FOR CLAIMS.....AM I SUPPOSED TO
    Message 1 of 18 , Jun 2, 2008
      SO, LET ME GET THIS STRAIGHT.....WE ARE A SOLE PRACTICIONER WITH AN
      INDIVIDUAL # AND A GROUP #.....I AM USING THE INDIVIDUAL # FOR CLAIMS.....AM I
      SUPPOSED TO USE THE GROU # FOR CLAIMS???????????
      I AM CONFUSED

      PAM SIMINGTON
      EDWARD B KAMPSEN MD PA
      813-877-2685





      **************Get trade secrets for amazing burgers. Watch "Cooking with
      Tyler Florence" on AOL Food.
      (http://food.aol.com/tyler-florence?video=4&?NCID=aolfod00030000000002)


      [Non-text portions of this message have been removed]
    • Karen Hurley
      Everyone is being told something different.? Our carrier told us (and I have it in writing), if the physician s business name is different than his own name
      Message 2 of 18 , Jun 2, 2008
        Everyone is being told something different.? Our carrier told us (and I have it in writing), if the physician's business name is different than his own name (like yours is below) you need an organization NPI and notify Medicare of it - so they can create a "business PTAN" - and you do that with an 855-I form (not an 855-B like others).? Our carrier is Trailblazer.

        Last week, Trailblazer's system went down (and so did NPPES - simultaneously).? I have a receipt for 2 claims sent with the individual number, prior to their system?going down?(the same day).? When I called the IVR lthe following day (and days afterward)- the two claims are not in the system.

        When I call the IVR with the individual PTAN and the organization NPI today - it recognizes both being linked together - but the claims are still not in the IVR.

        I have resent both claims today with the individual and the organization PTAN.

        I have to wait to see if the claims are accepted and if they eventually appear in the IVR.? If they do, then I will have my NPI issue solved for this client - and here's the thing:? it goes right back to the original way I stated the claims needed to be sent to begin with............and we still do not have anything from Medicare formerly linking the numbers together.

        I should know by tomorrow if the claims go through to Medicare under the organization NPI (block 33), with the individual in block 24J.


        Karen Hurley, CMM, CPC-I, LE
        President, HPMSI
        PO Box 159
        Waldorf, MD 20604-0159
        Tel: (301) 651-4767
        Fax: (240) 368-0059
        web: www.hpmsi.com


        -----Original Message-----
        From: kampsene@...
        To: CRN-L@yahoogroups.com
        Sent: Mon, 2 Jun 2008 8:52 am
        Subject: Re: [CRN-L] NPI Stories



        SO, LET ME GET THIS STRAIGHT.....WE ARE A SOLE PRACTICIONER WITH AN
        INDIVIDUAL # AND A GROUP #.....I AM USING THE INDIVIDUAL # FOR CLAIMS.....AM I
        SUPPOSED TO USE THE GROU # FOR CLAIMS???????????
        I AM CONFUSED

        PAM SIMINGTON
        EDWARD B KAMPSEN MD PA
        813-877-2685





        **************Get trade secrets for amazing burgers. Watch "Cooking with
        Tyler Florence" on AOL Food.
        (http://food.aol.com/tyler-florence?video=4&?NCID=aolfod00030000000002)


        [Non-text portions of this message have been removed]


        ------------------------------------

        http://www.codingandreimbursement.net
        Yahoo! Groups Links






        [Non-text portions of this message have been removed]
      • Martin Jensen
        I just downloaded the new NPPES file. They have added a new data element that might not have been there when you last updated their records: Is Sole Proprietor
        Message 3 of 18 , Jun 2, 2008
          I just downloaded the new NPPES file. They have added a new data element
          that might not have been there when you last updated their records:

          Is Sole Proprietor

          Go back to the records of the providers in question (if they are indeed Sole
          Proprietors) and check that box (or put a Y or whatever). (Or at least
          verify that it is already checked -- and print it to fax to your carrier!)

          That may help.

          Let us know whether that works, okay?

          Martin Jensen
          Healthcare IT Transition Group
          918-630-4417 (m)
          Author, The 2008 National Provider Identifier Contingency Status Survey
          http://surveys.hittransition.com/npi


          _____

          From: CRN-L@yahoogroups.com [mailto:CRN-L@yahoogroups.com] On Behalf Of
          Karen Hurley
          Sent: Friday, May 30, 2008 5:20 PM
          To: CRN-L@yahoogroups.com
          Subject: Re: [CRN-L] NPI Stories



          For me, I created the NPI records for my clients, and the information is
          completely accurate.

          It just comes down to the fact that CMS and the carriers *were not ready*
          for the sole proprietor/solo practitioner who was assigned only one provider
          number through their carriers for claims that covered both the provider and
          the entity.

          Someone seriously dropped the ball on this issue.? It is overly obvious they
          did not consider the fact that two fields could not emit the same
          information and 'pair up' to NPPES.

          An overly simple resolution would have been to create an appended number to
          the existing provider number - then associate it to the organization NPI -
          which all physicians WOULD NEED TO HAVE to bill as a business and receive
          payments.........

          But then again, they didn't ask us - they just listened to technicians who
          clearly were not polished or skilled enough to understand the construction
          of a claim.

          Now, I have to figure out why I have a receipt from Medicare that states
          they accepted my claims.............but 3 days later they are not in the
          IVR.......now, that's going to take some real explaining.

          Karen Hurley, CMM, CPC-I, LE
          President, HPMSI
          PO Box 159
          Waldorf, MD 20604-0159
          Tel: (301) 651-4767
          Fax: (240) 368-0059
          web: www.hpmsi.com

          -----Original Message-----
          From: Martin Jensen <martinjensen@ <mailto:martinjensen%40hittransition.com>
          hittransition.com>
          To: CRN-L@yahoogroups. <mailto:CRN-L%40yahoogroups.com> com
          Sent: Fri, 30 May 2008 5:06 pm
          Subject: RE: [CRN-L] NPI Stories

          Regarding the problems you mention.

          Before going through re-enrollment, I always suggest that providers check
          out their own NPI records at NPPES.

          It could be that the EIN or SSN was mistyped.

          It may also be that some other needed information (UPINs, etc.) are missing
          or incorrect.

          Also, an incorporated practice (or any number of other business types, like
          LLCs, or whatever) will need a separate NPI from the physician, even if they
          own the entire company.

          A "sole proprietorship" is the exception. The law sees the company and the
          individual as the same entity, and that means only one NPI -- a Type 1 NPI
          for the doc.

          There is a CMS FAQ about this issue with respect to NPI:
          http://questions.
          <http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_f
          a> cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_fa
          qid=6594

          Basic, easily digestible NPI info is on this two-page flyer, with links to
          some general resources inside CMS:
          http://www.cms.
          <http://www.cms.hhs.gov/NationalProvIdentStand/downloads/npi_fs_hcprov_indiv
          _> hhs.gov/NationalProvIdentStand/downloads/npi_fs_hcprov_indiv_
          012606.pdf

          It also has a link to the NPI enumerator page (aka NPPES) where they can log
          in and review and update their records (if they don't know their login ID
          and password, they can find help to get access). I believe they may have
          some specific instructions for solo practices, whether sole proprietors or
          otherwise.

          One significant note on the flyer says, "The sole proprietor must apply for
          the NPI using his or her own SSN, not an EIN even if he/she has an EIN. "

          Another important factoid: NPPES data gets "published" once a month, and
          they strip out the SSNs and EINs. But Medicare has a separate agreement,
          that gives them full access and they load it much more frequently. According
          to statements made by Medicare folks, it should only take two or three days
          for the changes you make to your NPPES record to be reflected in their
          crosswalk.

          Doesn't mean you SHOULDN'T update your enrollment (if they can tell you what
          needs to be fixed), but it is taking months to get the carriers to do the
          data entry on that side. Better to tweak your NPPES record first -- you
          control it, you can see it.

          Marty

          Martin Jensen
          Healthcare IT Transition Group
          918-630-4417 (m)
          Author, The 2008 National Provider Identifier Contingency Status Survey
          http://surveys. <http://surveys.hittransition.com/npi> hittransition.com/npi



          _____

          From: CRN-L@yahoogroups. <mailto:CRN-L%40yahoogroups.com> com
          [mailto:CRN-L@yahoogroups. <mailto:CRN-L%40yahoogroups.com> com] On Behalf
          Of
          Cyndee Weston
          Sent: Thursday, May 29, 2008 9:51 PM
          To: CRN-L@yahoogroups. <mailto:CRN-L%40yahoogroups.com> com
          Subject: RE: [CRN-L] NPI Stories

          Karen:

          I'm so glad you posted. You are not alone with a DME related problem.
          Here's a story from one of our member's:

          >>I have one provider I consult with, who is receiving this from Palmetto.
          So far I am being told his EIN is not properly linked, however he claims
          confirmation plus tested claims went through. I'm still trying to determine
          the problem and awaiting the actual rejection. When I type in the error into
          google, this is coming up,
          www.healthsystems.net/docs/HS_Feb_2008_EDI_webinar_final.pdf which seems to
          be related to Palmetto which applies to my providers error. My client also
          uses Gateway EDI so now I am wondering if it could be on their end which is
          what I will be checking first when I have the documentation I need.>>

          As many of you know, Gateway is one of the clearinghouse's that is still
          requiring legacy information on claim forms. This thread started with the
          following post:

          >>Well, it appears that the Medicare rejections have begun. I am getting
          this message (or some variation of it) on my clients who are billing
          Medicare:

          MSG-Y1K BILLING PROVIDER SSN OR EIN NOT ON CROSSWALK (REF-NM)

          Does anyone know what this means? Does it mean that the provider did not
          give their EIN or SSN when they got their NPI #? Or is it just a Gateway
          issue? >>

          The next reply said:

          >>We have also received this message. What it means is that when the doctor
          credentialed with Medicare they probably did not have a Federal ID number,
          they were using their social security number. Somewhere along the way, they
          did obtain a Federal Id number and that is what they registered with their
          NPI as being the Tax ID. Medicare is rejecting because the Tax Id (Social
          Security #) they have on file does not match what the NPI registration
          (Federal ID #) it says it should be. The doctor needs to send an updated
          855I to Medicare.>>

          Again, RE-ENROLLMENT; a word I am beginning to loath.

          Then, this comment >>It took Medicare 9 months to process my client's 855
          enrollment form to start with. Now it will be even longer.>>

          And finally, the consultant with the DME issue said >>This rules out my
          situation because indeed provider had Fed ID they used with the NPI
          Application.>>

          Is anyone else experiencing problems and if so, what are they? I suspect
          more issues will be uncovered as we continue post NPI deadline. I have sent
          emails to several clearinghouse contacts I have asking for rejection rates
          and info. We'll see whether or not it's forthcoming. Thanks again.

          Cyndee Weston

          Executive Director, AMBA

          www.ambanet.net/AMBA.htm

          Cyndeew@brightok. <mailto:Cyndeew%40brightok.net> net

          580 622-5809 Phone

          580 622-5810 Fax

          _____

          From: CRN-L@yahoogroups. <mailto:CRN-L%40yahoogroups.com> com
          [mailto:CRN-L@yahoogroups. <mailto:CRN-L%40yahoogroups.com> com] On Behalf
          Of
          Karen Hurley
          Sent: Thursday, May 29, 2008 8:04 PM
          To: CRN-L@yahoogroups. <mailto:CRN-L%40yahoogroups.com> com
          Subject: Re: [CRN-L] NPI Stories

          Too bad there isn't a blog for those of us actually pumping out the
          work............examples:

          - Yesterday, NPPES was down and so was Trailblazer (simultaneously).? When
          you called in the AM - solo providers could get information with their
          individual NPI and PTAN.? In the afternoon, when both systems were up - the
          individual NPI's are not recognized ("invalid") and you are required to put
          in your business?NPI if you are solo.

          - NHIC transitioned from EDI to CEDI (what the heck is the difference) and
          claims sent through PayerPath to CEDI evaporated - their answer?? REAPPLY
          FOR ELECTRONIC SUBMISSIONS !!!!!!!!!? Say what?? That takes months.........

          But so far, I appear to be the only DME submitter having problems - but I
          have claims with clearinghouse acceptance, but no Medicare
          receipt...........

          One of my clients said one of his office neighbors (a physician) was going
          out to his car yesterday and said this was the event that has finally made
          him officially retire.? It has just become far too overwhelming.

          Karen Hurley, CMM, CPC-I, LE
          President, HPMSI
          PO Box 159
          Waldorf, MD 20604-0159
          Tel: (301) 651-4767
          Fax: (240) 368-0059
          web: www.hpmsi.com

          -----Original Message-----
          From: Martin Jensen <martinjensen@ <mailto:martinjensen%40hittransition.com>
          hittransition.com>
          To: 'Medical Office Strategies' <medstrats@askleslie
          <mailto:medstrats%40askleslie.net> .net>; CRN-L@yahoogroups.
          <mailto:CRN-L%40yahoogroups.com> com
          Sent: Thu, 29 May 2008 6:30 pm
          Subject: [CRN-L] NPI Stories

          I have been madly posting NPI stories on my blog since Tuesday.

          Todays entries include:

          Medicare <http://blog.
          <http://blog. <http://blog.
          <http://blog.hittransition.com/2008/05/medicare-grants.html>
          hittransition.com/2008/05/medicare-grants.html>
          hittransition.com/2008/05/medicare-grants.html>
          hittransition.com/2008/05/medicare-grants.html>
          Grants 30-Day NPI Extension -- To Itself
          http://blog. <http://blog.
          <http://blog. <http://blog.hittransition.com/2008/05/medicare-grants.html>
          hittransition.com/2008/05/medicare-grants.html>
          hittransition.com/2008/05/medicare-grants.html>
          hittransition.com/2008/05/medicare-grants.html

          Emdeon Sees <http://blog.
          <http://blog. <http://blog.
          <http://blog.hittransition.com/2008/05/emdeon-sees-med.html>
          hittransition.com/2008/05/emdeon-sees-med.html>
          hittransition.com/2008/05/emdeon-sees-med.html>
          hittransition.com/2008/05/emdeon-sees-med.html>
          Medicare Rejects Up 4X, Medicaid 6X, Blues 2X
          http://blog. <http://blog.
          <http://blog. <http://blog.hittransition.com/2008/05/emdeon-sees-med.html>
          hittransition.com/2008/05/emdeon-sees-med.html>
          hittransition.com/2008/05/emdeon-sees-med.html>
          hittransition.com/2008/05/emdeon-sees-med.html

          Previously, some of the titles of interest include...

          Medicare NPI <http://blog.
          <http://blog. <http://blog.
          <http://blog.hittransition.com/2008/05/medicare-npi-cr.html>
          hittransition.com/2008/05/medicare-npi-cr.html>
          hittransition.com/2008/05/medicare-npi-cr.html>
          hittransition.com/2008/05/medicare-npi-cr.html>
          Crosswalk Secrets Revealed...
          http://blog. <http://blog.
          <http://blog. <http://blog.hittransition.com/2008/05/medicare-npi-cr.html>
          hittransition.com/2008/05/medicare-npi-cr.html>
          hittransition.com/2008/05/medicare-npi-cr.html>
          hittransition.com/2008/05/medicare-npi-cr.html

          Medicaid NPI <http://blog.
          <http://blog. <http://blog.
          <http://blog.hittransition.com/2008/05/medicaid-npi-co.html>
          hittransition.com/2008/05/medicaid-npi-co.html>
          hittransition.com/2008/05/medicaid-npi-co.html>
          hittransition.com/2008/05/medicaid-npi-co.html>
          Confession: Our Throughput is Down 90%
          http://blog. <http://blog.
          <http://blog. <http://blog.hittransition.com/2008/05/medicaid-npi-co.html>
          hittransition.com/2008/05/medicaid-npi-co.html>
          hittransition.com/2008/05/medicaid-npi-co.html>
          hittransition.com/2008/05/medicaid-npi-co.html

          There is also a link to the Modern Healthcare article that cites Cyndee and
          me as sources (Oklahoma rocks!):
          Modern <http://blog.
          <http://blog. <http://blog.
          <http://blog.hittransition.com/2008/05/modern-healthca.html>
          hittransition.com/2008/05/modern-healthca.html>
          hittransition.com/2008/05/modern-healthca.html>
          hittransition.com/2008/05/modern-healthca.html>
          Healthcare Covers NPI
          http://blog. <http://blog.
          <http://blog. <http://blog.hittransition.com/2008/05/modern-healthca.html>
          hittransition.com/2008/05/modern-healthca.html>
          hittransition.com/2008/05/modern-healthca.html>
          hittransition.com/2008/05/modern-healthca.html
          Direct:
          http://www.modernhe
          <http://www.modernhe
          <http://www.modernhe
          <http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=2008846521871>
          althcare.com/apps/pbcs.dll/article?AID=2008846521871>
          althcare.com/apps/pbcs.dll/article?AID=2008846521871>
          althcare.com/apps/pbcs.dll/article?AID=2008846521871

          Other stories I cite are listed here:

          NPI Stories - <http://blog.
          <http://blog. <http://blog.
          <http://blog.hittransition.com/2008/05/npi-stories---i.html>
          hittransition.com/2008/05/npi-stories---i.html>
          hittransition.com/2008/05/npi-stories---i.html>
          hittransition.com/2008/05/npi-stories---i.html>
          Is the Train Running or Wrecking?
          http://blog. <http://blog.
          <http://blog. <http://blog.hittransition.com/2008/05/npi-stories---i.html>
          hittransition.com/2008/05/npi-stories---i.html>
          hittransition.com/2008/05/npi-stories---i.html>
          hittransition.com/2008/05/npi-stories---i.html

          More importantly, that last link is where I am collecting first-hand
          accounts from providers and billers. Do you have a story to tell? Post it
          there, in the Comments section.

          Marty

          Martin Jensen
          Healthcare IT Transition Group
          918-630-4417 (m)
          Author, The 2008 National Provider Identifier Contingency Status Survey
          http://surveys. <http://surveys. <http://surveys.
          <http://surveys.hittransition.com/npi> hittransition.com/npi>
          hittransition.com/npi> hittransition.com/npi

          [Non-text portions of this message have been removed]

          ------------------------------------

          http://www.codingan <http://www.codingan
          <http://www.codingan <http://www.codingandreimbursement.net>
          dreimbursement.net> dreimbursement.net>
          dreimbursement.net
          Yahoo! Groups Links

          [Non-text portions of this message have been removed]

          [Non-text portions of this message have been removed]

          [Non-text portions of this message have been removed]

          ------------------------------------

          http://www.codingan <http://www.codingandreimbursement.net>
          dreimbursement.net
          Yahoo! Groups Links

          [Non-text portions of this message have been removed]






          [Non-text portions of this message have been removed]
        • Martin Jensen
          It s not an issue of whether you are a sole practitioner (a doctor who is the only physician in his/her own clinic), but whether the clinic itself is a
          Message 4 of 18 , Jun 2, 2008
            It's not an issue of whether you are a "sole practitioner" (a doctor who is
            the only physician in his/her own clinic), but whether the clinic itself is
            a "sole proprietorship" (a specific type of business entity, regardless
            whether it is a doctor's office or a grocery store or a manufacturing
            company, which is owned by a single individual who has not set the business
            up as a separate entity, such as a corporation, LLC, or a dozen other legal
            possibilities). Also IT DOESN'T MATTER WHETHER THE DOCTOR USES A DIFFERENT
            NAME. It's about how the business entity is legally defined.

            If you have both an individual number and a group number, then the practice
            SHOULD BE something OTHER than a sole proprietorship.

            In that case, the organization's NPI and name goes in as the billing
            provider, and the physician's NPI and name goes in as the rendering
            provider. I'm sorry that I don't have the paper claim form boxes memorized,
            but someone else on the list can surely help with this.

            Marty

            Martin Jensen
            Healthcare IT Transition Group
            918-630-4417 (m)
            Author, The 2008 National Provider Identifier Contingency Status Survey
            http://surveys.hittransition.com/npi


            _____

            From: CRN-L@yahoogroups.com [mailto:CRN-L@yahoogroups.com] On Behalf Of
            kampsene@...
            Sent: Monday, June 02, 2008 7:53 AM
            To: CRN-L@yahoogroups.com
            Subject: Re: [CRN-L] NPI Stories



            SO, LET ME GET THIS STRAIGHT.....WE ARE A SOLE PRACTICIONER WITH AN
            INDIVIDUAL # AND A GROUP #.....I AM USING THE INDIVIDUAL # FOR CLAIMS.....AM
            I
            SUPPOSED TO USE THE GROU # FOR CLAIMS???????????
            I AM CONFUSED

            PAM SIMINGTON
            EDWARD B KAMPSEN MD PA
            813-877-2685



            **************Get trade secrets for amazing burgers. Watch "Cooking with
            Tyler Florence" on AOL Food.
            (http://food.
            <http://food.aol.com/tyler-florence?video=4&?NCID=aolfod00030000000002>
            aol.com/tyler-florence?video=4&?NCID=aolfod00030000000002)

            [Non-text portions of this message have been removed]






            [Non-text portions of this message have been removed]
          • Martin Jensen
            Not sure whether to trust the IVR (Interactive Voice Response -- automated phone system). That phone system was never converted to NPI. In fact, that s one of
            Message 5 of 18 , Jun 2, 2008
              Not sure whether to trust the IVR (Interactive Voice Response -- automated
              phone system).

              That phone system was never converted to NPI. In fact, that's one of the
              reasons they used for continuing to issue their own numbers (UPINs suddenly
              became PTANs -- now you can't look up UPINs anymore -- and never could look
              up PTANs, but somehow everyone is suposed to know what they are).

              I would only trust the online system lookup. On the institutional side,
              this was FISS. Not sure what they call it on the Professional/Part B side.

              Martin Jensen
              Healthcare IT Transition Group
              918-630-4417 (m)
              Author, The 2008 National Provider Identifier Contingency Status Survey
              http://surveys.hittransition.com/npi


              _____

              From: CRN-L@yahoogroups.com [mailto:CRN-L@yahoogroups.com] On Behalf Of
              Karen Hurley
              Sent: Monday, June 02, 2008 8:11 AM
              To: CRN-L@yahoogroups.com
              Subject: Re: [CRN-L] NPI Stories



              Everyone is being told something different.? Our carrier told us (and I have
              it in writing), if the physician's business name is different than his own
              name (like yours is below) you need an organization NPI and notify Medicare
              of it - so they can create a "business PTAN" - and you do that with an 855-I
              form (not an 855-B like others).? Our carrier is Trailblazer.

              Last week, Trailblazer's system went down (and so did NPPES -
              simultaneously).? I have a receipt for 2 claims sent with the individual
              number, prior to their system?going down?(the same day).? When I called the
              IVR lthe following day (and days afterward)- the two claims are not in the
              system.

              When I call the IVR with the individual PTAN and the organization NPI today
              - it recognizes both being linked together - but the claims are still not in
              the IVR.

              I have resent both claims today with the individual and the organization
              PTAN.

              I have to wait to see if the claims are accepted and if they eventually
              appear in the IVR.? If they do, then I will have my NPI issue solved for
              this client - and here's the thing:? it goes right back to the original way
              I stated the claims needed to be sent to begin with............and we still
              do not have anything from Medicare formerly linking the numbers together.

              I should know by tomorrow if the claims go through to Medicare under the
              organization NPI (block 33), with the individual in block 24J.

              Karen Hurley, CMM, CPC-I, LE
              President, HPMSI
              PO Box 159
              Waldorf, MD 20604-0159
              Tel: (301) 651-4767
              Fax: (240) 368-0059
              web: www.hpmsi.com

              -----Original Message-----
              From: kampsene@aol. <mailto:kampsene%40aol.com> com
              To: CRN-L@yahoogroups. <mailto:CRN-L%40yahoogroups.com> com
              Sent: Mon, 2 Jun 2008 8:52 am
              Subject: Re: [CRN-L] NPI Stories

              SO, LET ME GET THIS STRAIGHT.....WE ARE A SOLE PRACTICIONER WITH AN
              INDIVIDUAL # AND A GROUP #.....I AM USING THE INDIVIDUAL # FOR CLAIMS.....AM
              I
              SUPPOSED TO USE THE GROU # FOR CLAIMS???????????
              I AM CONFUSED

              PAM SIMINGTON
              EDWARD B KAMPSEN MD PA
              813-877-2685



              **************Get trade secrets for amazing burgers. Watch "Cooking with
              Tyler Florence" on AOL Food.
              (http://food.
              <http://food.aol.com/tyler-florence?video=4&?NCID=aolfod00030000000002>
              aol.com/tyler-florence?video=4&?NCID=aolfod00030000000002)

              [Non-text portions of this message have been removed]

              ------------------------------------

              http://www.codingan <http://www.codingandreimbursement.net>
              dreimbursement.net
              Yahoo! Groups Links

              [Non-text portions of this message have been removed]






              [Non-text portions of this message have been removed]
            • HPMSI@aol.com
              Marty: We ll have to partially disagree on some of what you wrote below. It is not possible to have: John Smith, MD (in block 31) John Smith, MD, PA (in
              Message 6 of 18 , Jun 2, 2008
                Marty:

                We'll have to partially disagree on some of what you wrote below. It is not
                possible to have:

                John Smith, MD (in block 31)

                John Smith, MD, PA (in block 33)

                .......unless you have 2 NPI's. The solo practitioner can be a sole
                proprietor or a corporation. The issue is if you have created a name for a business
                - AND - you have a tax ID number for that business, you need two NPI's. If
                the tax ID reflects the fact you have applied for a business name and
                structure, then you need an organization NPI to submit claims.

                If the NPPES has been updated to include the correct terminology, it's about
                time. They have created a problem without considering that Medicare did not
                assign two provider numbers to crosswalk to.

                My point was proven today when I received a call from Medicare. They've
                done exactly as I had thought they should have done more than a year ago by
                APPENDING a new number to the existing sole proprietor's Medicare provider
                number. Now - we have two numbers at Medicare *not a group*) and two NPI's.

                This call came the day after Medicare's IVR recognized the organization NPI
                for my client.

                According to the person who called, Trailblazer *will not* be sending out
                letters to those who submitted an 855-I to connect the two...........only a
                phone call. I made the rep repeat the number 3 times before letting her hang
                up. I've documented the conversation in email and sent it to my client.

                Karen Hurley

                In a message dated 6/2/2008 12:02:44 P.M. Eastern Standard Time,
                martinjensen@... writes:

                It's not an issue of whether you are a "sole practitioner" (a doctor who is
                the only physician in his/her own clinic), but whether the clinic itself is
                a "sole proprietorship" (a specific type of business entity, regardless
                whether it is a doctor's office or a grocery store or a manufacturing
                company, which is owned by a single individual who has not set the business
                up as a separate entity, such as a corporation, LLC, or a dozen other legal
                possibilities). Also IT DOESN'T MATTER WHETHER THE DOCTOR USES A DIFFERENT
                NAME. It's about how the business entity is legally defined.

                If you have both an individual number and a group number, then the practice
                SHOULD BE something OTHER than a sole proprietorship.

                In that case, the organization's NPI and name goes in as the billing
                provider, and the physician's NPI and name goes in as the rendering
                provider. I'm sorry that I don't have the paper claim form boxes memorized,
                but someone else on the list can surely help with this.

                Marty

                Martin Jensen
                Healthcare IT Transition Group
                918-630-4417 (m)
                Author, The 2008 National Provider Identifier Contingency Status Survey
                http://surveys.hittransition.com/npi


                _____

                From: CRN-L@yahoogroups.com [mailto:CRN-L@yahoogroups.com] On Behalf Of
                kampsene@...
                Sent: Monday, June 02, 2008 7:53 AM
                To: CRN-L@yahoogroups.com
                Subject: Re: [CRN-L] NPI Stories



                SO, LET ME GET THIS STRAIGHT.....WE ARE A SOLE PRACTICIONER WITH AN
                INDIVIDUAL # AND A GROUP #.....I AM USING THE INDIVIDUAL # FOR CLAIMS.....AM
                I
                SUPPOSED TO USE THE GROU # FOR CLAIMS???????????
                I AM CONFUSED

                PAM SIMINGTON
                EDWARD B KAMPSEN MD PA
                813-877-2685



                **************Get trade secrets for amazing burgers. Watch "Cooking with
                Tyler Florence" on AOL Food.
                (http://food.
                <http://food.aol.com/tyler-florence?video=4&?NCID=aolfod00030000000002>
                aol.com/tyler-florence?video=4&?NCID=aolfod00030000000002)

                [Non-text portions of this message have been removed]






                [Non-text portions of this message have been removed]


                ------------------------------------

                http://www.codingandreimbursement.net
                Yahoo! Groups Links










                **************Get trade secrets for amazing burgers. Watch "Cooking with
                Tyler Florence" on AOL Food.
                (http://food.aol.com/tyler-florence?video=4?&NCID=aolfod00030000000002)


                [Non-text portions of this message have been removed]
              Your message has been successfully submitted and would be delivered to recipients shortly.