Confused by acronyms and terms? I got you!

It occurred to me that while most of us have been in practice for years and understand commonly used acronyms and terms, that’s not true for new therapists. In this article, I will define some to help you along this journey.

What’s an NPI? This stands for National Provider Identification. It was created as a mandate of the HIPAA law and provides a way to avoid fraud and abuse. It means that all of a provider’s billing and insurance activity is tracked using the NPI. If you are a practicing health care provider and billing insurance or providing clients with receipts for reimbursement through their insurance company, you need an NPI. It takes less than five minutes to apply by going to this website– https://nppes.cms.hhs.gov/#/. If you are starting a group practice you will also need an NPI 2 or also known as a group NPI and apply for it using the same process described above.

I typically advise professionals not to use their home address since it does out on a public domain.

This brings us to the taxonomy code. This code is merely a way of classifying professionals. It works with your NPI when doing billing. The taxonomy contains ten characters. Like the NPI, there is a taxonomy for individuals and then one for a group. When searching for the correct taxonomy for you, make sure it corresponds with your degree and license level.

CAQH–This is a nonprofit agency that provides a litany of services for health care professionals and organizations. However, it’s most commonly known for being a centralized organization that collects and houses data for providers who wish to accept insurance. Most insurance companies use CAQH to obtain your data to make sure that you meet the qualifications to contract with their company. Data collected–specifics about your practice, a copy of your degree, up to date malpractice insurance, your professional license and more. Once you complete the online application, you will receive an email indicating that your profile is approved. Don’t get too excited because the next step is to apply to the insurance companies directly. Each insurance company a process for completing this step. It’s best to go to their website, search under provider information and look for information specific to behavioral health providers.

Credentialing

This is the process that you go through with an insurance company to get a contract. The credentialing process involves completing the CAQH, insurance application, having it reviewed and finally, executing a contract with the insurance company. It’s a huge pain, but necessary part of the process of accepting insurance.

BAA–business associate agreement

You need to have a business associate agreement with anyone who handles protected health information. This can include organizations that transmit, receives, creates, stores maintains protected health information. These are some organizations that you should have a signed BAA with– electronic health records, insurance clearinghouse, email, phone apps, records storage companies. You do not need a BAA with employees. In my experience, most of these organizations have BAAs that they are willing to execute with you. Always ask. If they do not, then find a template online that you can use. If they are unwilling to sign one, then you might want to consider not doing business with them.

That’s all the energy I have to write about today! There are lots of other terms and if there is one you’d like me to explain further, comment below. Would you also share this with someone else who is struggling to pull all of this stuff together?

If you want to grow your practice, but feeling stuck, stressed or need guidance, check out the University of Private Practice (UPP). We just kicked off the Spring 2019 session. While that cohort is closed, if we get enough, we’ll open a second cohort. Click this link now and read more about the UPP. https://lisasavagelcsw.lpages.co/office-hours/

Posted in

1 Comment

  1. Bridgette Montgomery on January 25, 2019 at 4:04 am

    Nice!