In Episode 15, Danielle asks Katia about the process of switching from a solo to a group practice and the ins and outs of setting up this structure when accepting insurance. Katia answers questions about infrastructure, changing the credentialing status, as well as general billing for a group. Visit our Facebook page for show notes and resources for this episode.
Out of Network Billing TipsJuly 9, 2018 - 7:00 amHere are some tips to ease out of network billing confusion: What/Who is Out Of Network? Clinicians who have not signed a contract with an insurance company and do not have to abide by a contracted rate. Can still be subject to insurance audits for medical necessity and are still considered a HIPAA-covered entity. […]
6 Tips to Get Through a Care Review With an Insurance CompanyJune 26, 2018 - 7:00 amYou go to check your voicemail after a long day of seeing clients and you hear the message you’ve been dreading. It’s a representative from an insurance company wanting to do a care review on one of your clients and they’ve asked you to call them back. AHHHHH—but wait! Don’t panic. You’ll be just […]
Insurance and Expanding into a Group PracticeMay 21, 2018 - 5:00 amFirst of all—congratulations! If you are reading this post, that means you are at least thinking about expanding your practice and forming a group, which hopefully means you have a successful group practice or maybe just big dreams! For the sake of this blog post, I am going to assume that you are in a […]
What Clinicians Need to Know About the Interactive Complexity CPT Code (90785)May 7, 2018 - 10:25 am
2 Options for Out-of-Network Billing 
Thanks for the video. This was really helpful. The one question I have that wasn’t discussed. At what point along this journey will I need to have a physical address for my new group practice? Before I get a group Tax ID? Before I become an S-Corp? Before I get a Type II NPI? It’s been a while since I started my solo practice, so I’ve forgotten. Thanks!
Hi Mike–good question. You could use your home address for your Tax ID (billing address), but you will need an office address in order to switch your credentialing/contracts. You could use your current office address if you have one.
does this apply if I already have contracts under my company name? I did all of the things initially, LLC, tax ID, NPI 2, and contracted with insurances under the company and NPI 2 do I need a new contract?
No, you do not need a new contract as you are already credentialed as a group.
I am looking to change my private practice over to a group practice, I am switching my name to an LLC as well and will be getting a new tax ID number and i guess an NPI II number as well since I already have one. What do i do in the mean time with my current sole proprietor name and billing bc I do not want to go months without being paid bc I am trying to get recredentialed? Do you know the process? Would I need to close out my sole proprietor name after I open the LLC or can I keep the name in addition to the new LLC name but only bill under the group after its established? Sorry for all the long questions. I am trying to avoid the insurance companies not paying while I am trying to add the new group name as my income is a necessity as many others would agree.
Thank you,
This fear is what kept me from switching my solo credentialing to group credentialing for ohhh 3 years haha. You can continue to bill under your solo EIN while the new group contract/EIN is being executed, at least that’s been my experience when switching my EIN with all major insurance companies. Hope this helps!
Excellent podcast. How is this information different if you are hiring an independent contractor verses an employee?
Thanks! We hope to release more episodes soon once our group practices settle down! There are lots of differences between the two as far as how both can operate within your business and the level of control you have over them etc. As far as billing, most practices set-up ICs and W-2s the same where they panel them under their group contracts/the group EIN and the practice gets paid by the insurance company. For ICs–they should essentially do their own credentialing and billing or at least given the choice/option as they contract with the practice and are not employees. This should all be run by an employment attorney in your state though, I’m not an attorney.
I currently have an NPI 1 and have an LLC. I would like to switch over to a group practice and save $$ by not changing name etc. I wonder if I could just get an NPI 2 with out changing my business name and tax ID. Is that possible? And maybe it would make the transition easier for the insurance companies. If I did that, it seems that I could just change the box 33 info once I get the all clear from insurance companies. Changing tax ID with Aetna will take at least 6 months from all of my experience and experience with colleagues.
Also I was wondering if you have LAC or other associate level (not fully licensed) counselors on your bill if their NPI would go in Box 24 J or if that would be the supervising clinician. Thanks for all of the information! It has been most helpful.
Hi Jamie–just getting around to seeing comments. If you do not have group contracts in place already, you will need to execute group contracts with insurance companies. In my experience, this takes 1-2 months.
In most states, provisionally licensed clinicians cannot bill insurance. Some panels allow them to credential on group contracts and bill as the rendering provider, while others do not and do not allow their ‘supervisor’ to be the rendering provider. It depends on the insurance company.
Hope this helps!
I am following up with the exact question than Jamie (above). I have an LLC, group NPI and EIN. Since my EIN and LLC are linked already can I Just begin with the group contract? Do I have to change my EIN? And in the W9, how do I chose?
If you have an LLC, that is a group entity. You can get group contracts with the panels that allow you to without a minimum amount of clinicians. If you paneled with your LLC and NPI 2 from the get go, you most likely already have group contracts.