Transcript

00:01.28
Liath
So A big question that keeps coming up from our folks in the the group practice space has been  that you know if the practice the group practice is opting out or enrolling. That’s done under the practices npi 2 nber. But then the npi one which is tied to the individual Clinicians also has to be included like paired with that for either opting out or. Enrolling So What happens in a group practice setting where the practice wants to opt out but they have a clinician who works in a hospital as as well or  has their own private practice.

00:56.70
Gabrielle
So when you are opting out. You are always listing the individual’s information and the individual’s npi and their license nber so it is tied to the npi one. So if somebody is opting out. They’re opting out as an individual.

00:56.56
Liath
How does that work.

01:15.65
Gabrielle
And that is important to know and can be problematic with what we were. You were just saying is that if somebody is in your group practice. You want to opt them out and they also work in a hospital that can you know where there may be billing medicare for them that could be a problem because it’s tied to their Npi one.

01:16.56
Liath
.

01:31.88
Liath
, reasons.

01:35.44
Gabrielle
So like the best way to probably get around that is to just not opt out for that person and to not give that person any Medicare clients and so , you know if you’re a private pay practice. For example I would just.

01:43.47
Liath
Issues.

01:52.27
Gabrielle
Checking with any incoming clients if they have medicare and you can just ask them. You might want to have something on your intake form that says like by checking this box I attest that I’m not a Medicare beneficiary or something like that. .

01:59.96
Liath
, is is.

02:08.51
Gabrielle
But you might just want to do a little extra due diligence on the front end  in that kind of a situation because it will be tied to their npi one which could impact them if they are working somewhere else where they do need to build medicare.

02:10.28
Liath
We said.

02:24.28
Liath
Ah, that’s really helpful clarification because I can see that being really impactful for both group practices and for for their team members because I know you also said that if you opt out. You have to and you don’t rescind that opt out within sixty days the sixty day kind of Grace period window.  that you then can’t enroll for 2 years right? So that can be pretty consequential. .

02:54.50
Gabrielle
Who he yeah.

03:01.69
Liath
For for individual clinicians and and team members and their future plans potentially right? , so then the the best way to manage that would be if the practice is opting out under their Npi 2

03:07.93
Gabrielle
Yep yep.

03:19.65
Liath
To list the npi ones and the individuals who are part of that opt out as just the specific providers who are in fact, wanting to opt out understand the consequences of that and then for any providers who , don’t.

03:32.12
Gabrielle
Be here.

03:39.50
Liath
Want to be part of the opt out you don’t list their npi ones in the individual’s information but make sure that they aren’t , seeing any clients with Medicare in your in your practice.

03:54.69
Gabrielle
And I don’t even think you can do it just by the group practice like you can decide as a group practice. But I’m I’m actually looking at the opt out form right now and it just asks for the specific.

03:59.38
Liath
Anything. Mission.

04:11.20
Gabrielle
Practitioners information and credentials and Npi and all of that stuff so you would need to.

04:17.52
Liath
So it’s on an individual base. Oh so but opt Outs individual basis versus , the enrollment which is I too.

04:27.61
Gabrielle
Which is the enrollment would be like yeah exactly so it is different and so you would need to do an opt out form for every single provider that’s opting out. So if you have a really big group practice.

04:41.50
Liath
Oh yeah, yes, yes, definitely delegate that Okay, that’s .

04:46.48
Gabrielle
You might want to delegate that. Ah.

04:55.72
Liath
That is good information really important and something I know that will be really helpful to have clarity on for all the group practice owners who are are trying to make this decision. Okay, thank you.

05:13.44
Gabrielle
Yep.

05:15.69
Liath
Okay, awesome. Thanks so much Gabrielle.

 

With Guest:
Gabrielle Juliano-Villani, LCSW

Founder of Medicare Consulting for Therapists

Welcome solo and group practice owners! We are Liath Dalton and Evan Dumas, your co-hosts of Group Practice Tech.

In this episode, Liath chats with Gabrielle Juliano-Villani, LCSW — founder of Medicare Consulting for Therapists — about navigating Medicare considerations as a mental health provider.

We discuss fears and misconceptions around being a Medicare provider; upsides to being a Medicare provider; how opting in and out of Medicare works with multiple providers; what the enrollment process entails and where people get tripped up; what documents you need to have ready to enroll; how long the process takes; reimbursement timeframes; auditing and documentation; and our upcoming Q+A session with Gabrielle on this topic. 

Resources are available for all Group Practice Tech listeners below:

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Resources for Listeners

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