Navigating Healthcare Contracts: Maximizing Reimbursement with Taxonomy Codes and NPI Numbers
This blog post is explores the importance of understanding MPI numbers, taxonomy codes, and contracts for new doctors and providers starting their own practices.
What are MPI numbers, taxonomy codes, and contracts?
MPI (Master Patient Index) number: A unique identifier assigned to a patient across different healthcare providers.
Taxonomy code: A code that identifies a healthcare provider's specialty.
Contract: An agreement between a healthcare provider and an insurance company that outlines the terms for reimbursement.
How do they work together?
When you contract with an insurance company, they will look at your MPI number and the associated taxonomy code to determine your specialty and what services you are eligible to bill for.
The taxonomy code also helps insurance companies determine the appropriate place of service code, which affects reimbursement rates.
For example, an urgent care center would have a different place of service code than a doctor's office, and this would be reflected in the contract.
Why is it important to get this right?
If your taxonomy code is not accurate, you may not be eligible to bill for certain services, or you may be reimbursed at a lower rate.
You may also have difficulty getting contracts with insurance companies if your taxonomy code does not reflect your specialty.
Taxonomy accuracy matters most in specialties with many recognized subspecialties under one umbrella. Neurology is a good example: clinical neurophysiology, sleep medicine, vascular neurology, neuromuscular medicine, and pain medicine each carry their own taxonomy code, and payers use them to decide which services a provider is contracted to perform. A neurologist enrolled under the general neurology taxonomy who begins reading sleep studies or performing EMGs may find those claims denied as outside the credentialed scope, even though the provider is fully qualified. Reviewing taxonomy against the actual service mix before enrollment, and updating it when the practice adds a line, is part of what a TruCare neurology billing service checks during setup.
What can you do to make sure you are getting the most out of your contracts?
Make sure your MPI numbers and taxonomy codes are accurate and up-to-date on the National Plan and Provider Enumeration System (NPPES) website.
Communicate your intentions and specialties clearly to insurance companies when negotiating contracts.
Be aware of the different place of service codes and how they affect reimbursement.
Additional tips:
If you are unsure about any of this, consult with a healthcare consultant or attorney.
There are many resources available online and in libraries to help you learn more about healthcare contracting.
By following these tips, you can ensure that you are getting the most out of your healthcare contracts and maximizing your reimbursement.
I hope this blog post was helpful! Please leave any questions or comments below.
