Monday, August 13, 2007

Group practices need NPI numbers

In order for group practices to bill Medicare electronically they will need a group NPI number. They are required to obtain and use these group NPI numbers to identify themselves as a Billing and Pay-to providers in Medicare claims.

Medicare also requires rendering providers by identified by NPI number on the claims whether or not these rendering providers are covered providers. Group Practices that are enrolled in Medicare will want to ensure that their members (physician or other practitioners) obtain NPI numbers in order to receive payments for the group practice by Medicare.

Office's can have a Facility NPI, Group NPI and individual provider NPI. Verify with Medicare all numbers as they are different.

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1 comment:

  1. "Office's can have a Facility NPI, Group NPI and individual provider NPI."

    True -- sort of. If the practice is a sole proprietorship, then it cannot obtain an NPI on its own -- in this case, you need to use the physician/owner's NPI. CMS recently updated the NPPES system (where providers create and maintain their NPI records) to indicate that an individual also does business as a sole proprietorship. For other types of organizations, the provider gets to decide how many NPIs to obtain, subject to rules that prevent duplication (i.e. you can obtain NPIs for different locations, or for different types of services at the same location, but not for identical services at the same location).

    This very long link will list all the FAQs at CMS that address NPI:

    If that doesn't work, go to my blog via this shorter address: