Navigating Healthcare Contracts: Maximizing Reimbursement with Taxonomy Codes and NPI Numbers

[@yosefnathan8648]

thanks for this great video!

[@navigatingthebusinessofmed8251]

@@yosefnathan8648 thank you for watching!

[@itsirkeel]

The longer I'm in the field, the more I realize that the contracts between the clinicians and insurance companies are what matters the most. But except for a deep dive like this, it feels like that's something people try to kind of keep under wraps about just how important it is. Explaining that there's nothing to be done about a contractual reimbursement rate until a contract is renegotiated is something I've brought up again and again when trying to explain paltry reimbursement rates. "Why aren't we getting more?" and I've had to say, "the clinician somewhere, somehow signed something agreeing to that dollar amount." U.S. health insurance is level upon level of crazy complexity at this point. Thank you for another super helpful video!!

[@navigatingthebusinessofmed8251]

Thanks for watching!

[@rosegurlmd]

Great video, informational as always! Could I request a video: highlights/tips for Pediatric Clinic? I appreciate you!

[@navigatingthebusinessofmed8251]

Thank you so much for your support! I’m happy to do a video for you, but I do have a question- are you looking for tips/highlights for operations, revenue cycle, workflows or what specifically? Thanks again!

[@rosalindlopez9719]

@@navigatingthebusinessofmed8251 General tips/highlights would be great!

[@lalanivar448]

How do you know whether you should use a group taxonomy or a providers taxonomy when billing?

[@navigatingthebusinessofmed8251]

They should be similar or related. If you bill under the group tax ID and NPI, then you would use the group taxonomy, and if they require the provider taxonomy, you would include that as well. It is all dictated by the insurance company and not all need the taxonomy code on claims. Thank you for watching!

[@lalanivar448]

The group can have them listed taxonomies but not all are primary. If billing under the group with a rendering provider would is it best to use a multi specialty or the taxonomy that is closely related to the specialty?

[@navigatingthebusinessofmed8251]

@@lalanivar448 it depends on your specialty. If you have many different specialists in one clinic then multi specialty taxonomy is good as primary then list each specialty taxonomy as the other ones. That should work just thinking off the top of my head without knowing your specific situation.

[@lalanivar448]

Yeah I was thinking the same thing in terms of the multi group but wasn’t sure since I am dealing with medical and behavioral health billing. Is there a way to ask a more specific question directly to you?