As an independent nurse practitioner and sole proprietor, you are likely familiar with group National Provider Identifier (NPI) numbers. A group NPI number is a unique identification number assigned to a group or organization such as a medical practice, clinic, or hospital. This number is used to identify the group when billing for services, insurance claims, and other administrative purposes.
Having a group NPI number allows independent nurse practitioners with sole proprietorship to work collaboratively with other healthcare providers, such as physicians, within the same organization or practice. It also streamlines administrative tasks such as billing and insurance claims, so Nurse Practitioners can more efficiently manage their practice and focus on providing quality patient care.
What is the Difference Between Type 1 and Type 2 NPI Numbers?
NPI type numbers are unique 10-digit identification numbers assigned to healthcare providers by the Centers for Medicare and Medicaid Services (CMS). They are required by all healthcare providers who transmit electronic health information and are used for various purposes, including identifying providers in insurance claims and other transactions.
Type 1 individual NPI numbers are assigned to healthcare providers, such as physicians, nurse practitioners, and other clinicians. These numbers are based on the provider’s social security number and are used to identify the provider as an individual. Type 1 NPI numbers are useful for independent nurse practitioners who work for themselves and do not have any other employees. They are also useful for part-time practitioners who work for multiple organizations.
On the other hand, Type 2 group NPI numbers are assigned to healthcare organizations, such as hospitals, clinics, and other institutions. These numbers are used to identify the organization as a whole, rather than an individual provider. Type 2 NPI numbers are useful for nurse practitioner groups or practices that have multiple providers working for them. They are also useful for billing purposes when a group or practice is submitting claims to insurance companies.
While both Type 1 and Type 2 NPI numbers are necessary for conducting business as a nurse practitioner, choosing the right type depends on your practice’s structure and needs. As an independent nurse practitioner, you have the flexibility to choose the type that suits your practice the best. The Internal Revenue Service also assigns a tax identification number (TIN) to each practice for tax purposes.
Obtaining a Group NPI Number
The purpose of obtaining a group NPI is to establish yourself as a group or clinic versus an independent practitioner. For a group NPI application, you will need to have at least two individual NPIs. The two NPI numbers that come together to form the group NPI can belong to the same or different healthcare providers.
Once you have your individual NPIs, you can go to the National Plan and Provider Enumeration System (NPPES) website (https nppes.cms.hhs.gov) to create your group NPI. This process can be quite straightforward, and you will receive your group NPI within a couple of weeks.
After obtaining your group NPI, it is essential to familiarize yourself with how to use it. You will be using your group NPI for all billing and administrative purposes. It is critical to ensure that all your providers bill using the group NPI and keep it updated in your files to avoid rejected or denied claims.
Advantages of Having a Group NPI Number
A group NPI is beneficial, especially for practices that are just starting, as it sets a good foundation for the future. By having a group NPI, you are establishing yourself as part of a professional healthcare group or clinic. Other benefits include:
Having a group NPI number simplifies the billing process, especially when working with multiple insurance companies. Instead of needing to fill out individual NPI numbers, an independent nurse practitioner can use their group number on a claim form. This streamlines the process and can reduce the risk of errors during the billing process.
Improved Reimbursement Rates
Using a group NPI number can lead to better reimbursement rates especially when working with health plans that have narrow networks in their area. Since the group NPI indicates a larger provider entity than individual NPI, insurance providers are more willing to negotiate the rates. This ultimately makes the practice more profitable, ensuring that the NP group practice receives the appropriate payment for their services.
Easier Collaboration with Other Healthcare Professionals
Sometimes, independent nurse practitioners may need to work with other healthcare professionals, especially when it comes to treating patients with complicated medical conditions. In such cases, obtaining a group NPI provides more clout especially when requesting referrals or ordering diagnostic tests. Using a group number, hospitals and other medical practices are more willing to work with the nurse practitioner since they are seen as part of a larger, more reputable entity.
Improved Tracking for Patient Outcomes
Independent nurse practitioners who have group NPI numbers can also benefit by using this to track patient outcomes and co-morbidities. Since they can see the larger picture of their practice, they have access to a broader array of data that pertains to their patient population. This, in turn, helps them identify gaps and opportunities that they can use to improve the patient’s experience.
Maintaining Compliance with Group NPI Requirements
To maintain compliance with group NPI regulatory requirements, independent nurse practitioners must ensure that all healthcare providers and organizations within their practice have a unique individual NPI and use the same group NPI when billing for services. If any provider in the practice has a different group NPI, it can lead to billing errors, claim rejections, and delay in receiving payments from the Centers for Medicare (CMS).
Another crucial aspect of maintaining compliance is keeping accurate records of all services rendered and billing activities. Independent NPs should keep their records up to date and make sure that all claims are submitted on time. Failure to keep accurate records or delayed submission of claims can result in non-compliance, which could lead to hefty fines, loss of revenue, or worse, legal action.
Independent NPs should also ensure that their practice is HIPAA compliant. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that sets standards for protecting sensitive health information. HIPAA compliance is critical for NPs to avoid data breaches and unauthorized disclosure of patients’ personal health information.
Another critical aspect to consider when maintaining compliance with Group NPI requirements is having a solid system in place to manage billing and claims. Many independent nurse practitioners opt for billing software to automate and streamline the billing process. Efficient billing software ensures that records are kept up to date, and claims are submitted on time, leading to better compliance and increased revenue.
Resources for Obtaining and Using a Group NPI Number
NPs are aware of the importance of an NPI number, which allows them to bill Medicare and Medicaid for their services, but they may not know the resources available to them. One valuable resource available to independent nurse practitioners seeking a group NPI number is the National Provider Identifier Standard (NPS) website. Here, you will find information about how to apply for an NPI, tips on how to complete your application, and information on how to use your NPI number to bill for services.
Other resources that may be helpful for NPI applications include professional organizations such as the American Association of Nurse Practitioners, which provides educational resources for independent practitioners, including tips on how to get a group NPI number or get an NPI replaced. Additionally, many insurance companies offer resources on how to use your group NPI number to bill for collaborative services, which can provide valuable insights into the reimbursement process.
NP Advantage Can Help
Obtaining and utilizing a group NPI number can be a nuanced process for independent nurse practitioners, but the benefits outweigh the challenges. As you embark on your journey to independent practice, the NP Advantage team is at your side. Our team gets your practice up and running and provides ongoing support so that you can enjoy the benefits of nurse entrepreneurship.