Many problems that we see practices or providers run into is when a doctor decides to change practices. They don’t realize what needs to be done to make sure payment for their services is made to the new practice. There are 3 key things that need to be done when doctors switch practices.
First, all insurance carriers need to be contacted to make the necessary changes. If the provider is leaving a practice where all of the benefits for their services were assigned (or paid) to the group they belonged to then they need to notify the insurance carriers that they are leaving that group.
If they are joining a new group, or forming their own practice they need to notify the insurance carrier of that as well. They want to make sure their services are going to be paid to the appropriate practice.
Each carrier has different requirements or forms that they need completed in order to do this. It is important that the correct paperwork is done. You can’t just send out a blanket letter and expect that to work.
For example, a provider called me the other day to say that he had recently started his own practice but he wasn’t getting any payments from Medicare. I asked if they had notified Medicare of his change. He said he had sent a letter. Well that doesn’t work for Medicare. You must complete a CMS 855I form to make changes to an individual provider number. Even if you just move to another suite in the same building.
Bottom line, the first thing you need to do is to make sure your services are going to be paid to the correct place.
Second, you need to make sure that your practice address is updated. This is usually done at the same time you are updating the payment information. The forms required to be submitted also ask for the new practice address and other info (phone, fax, etc.). It is important though that you make sure the address the insurance carrier has on file for you is accurate.
Third, you need to contact NPPES and update your information on the NPI enumerator’s system. If you have your login information you can simply log in and make the changes yourself. If you don’t you will want to call NPPES and get your login info so that you have access to it. You will want to keep your information associated with your NPI number current.
So, if a provider is planning on changing practices and they want to ensure a smooth transition, they will have a better chance if they make sure these 3 things are done prior to the change, or at least as soon as possible
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