Counseling Today, Private Practice in Counseling

Deadline for NPI approaching quickly

Robert J. Walsh and Norman C. Dasenbrook August 12, 2007

Q: I’m a bit confused and hope you can help me. I just opened a private practice at the start of the month and will begin seeing fee-for-service (private pay) clients beginning this week. I just found out about NPI (National Provider Identifier) numbers yesterday when ordering my imprinted HCFA forms. Since I am not on any insurance panels and will not get reimbursed by insurance companies (clients will submit their HCFA billing forms to their insurance company for reimbursement), do I need an NPI?

A: It is not necessary to get an NPI if you never bill managed care or insurance. If the client sends the bill on to his or her insurance, you may need an NPI. We recommend you obtain one regardless.

Q: I am having some difficulty getting started. I received my tax ID number (employer ID), but I cannot seem to find what the NPI number is. Additionally, CAQH (the Council for Affordable Quality Healthcare) is giving me difficulties with the information I need from them. I am not sure exactly what they do either. Please help!

A: We have had many questions about this as the deadline for obtaining your NPI approaches, so we will provide this information again:

Important date! May 23 is the deadline for obtaining your NPI. The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard unique identifier for health care providers. Information can be obtained at www.cms.hhs.gov/nationalprovidentstand/, and an application can be downloaded at https://nppes.cms.hhs.gov/NPPES/Welcome.do. Additional information regarding private practice issues is available on the ACA website at www.counseling.org/Counselors/. From this page, click on “Private Practice Pointers” (note that this is an ACA members-only section).

CAQH information is available at https://caqh.geoaccess.com/oas/. Through CAQH, a counselor can submit a credentialing application that can be accessed by more than 100 insurance and managed health care companies.

We recommend you go through Aetna’s Credentialing Customer Service Department. Call 800.353.1232 and ask to be referred to CAQH to receive an “identification number.” Online, Aetna has a helpful link at www.aetna.com/provider/credentialing.html that will facilitate this process. Just fill out the Aetna application request form, and you will be added to its CAQH-Aetna Provider Application Roster.

You can try this yourself, or you can contact Netsource Billing (call Donna at 866.441.1591), which will process your CAQH application for a fee.

Q: My question concerns a situation in which one person holds ownership in a private practice and allows another person to sublet an office. They do not share in the practice and are not partners. The counselor pays rent to the private practice. My thoughts are that the person who holds the highest coverage amount could be drawn into litigation in the event of an injury or claim.

A: The good news is that as a profession, counseling is not at the top of the list for lawsuits. Moreover, malpractice insurance for counselors is available at very reasonable rates. It goes without saying (even though we are saying it) that all counselors in private practice must have malpractice insurance. You do not have to do anything wrong or negligent to be sued.

We have never heard of a counselor being targeted in a lawsuit because of having the highest coverage. The minimum malpractice coverage required by insurance and managed health care companies is $1 million/$3 million. Malpractice insurance is available through the American Counseling Association Insurance Trust (call 800.347.6647 ext. 284). We recommend getting as much coverage as possible. Peace of mind is worth the extra cost.

Q: I’ve noticed that several of my clients (private practice) are reporting higher copays and deductibles as of Jan. 1 2007. I’m a master’s-level (LPC) clinician in Missouri. When BlueCross BlueShield was bought by Anthem and the new year began, this is when the higher copay started. Now, instead of an office visit copay of perhaps $25, my clients’ plans have me as a “specialist,” and the copay can be as high as $50. I’ve been shocked and saddened by this practice, as it often either meant that my clients couldn’t come to therapy regularly or decided to end therapy altogether.

Have you heard of this? Will the new (mental health parity) bill attend to this issue? I think it’s just a way for Anthem to have its clients pay unfairly for more of their mental health or substance abuse treatment. So far, Anthem is the only company I’ve seen do this. I’d appreciate hearing your feedback on this issue.

A: Yes, this has happened, along with much higher deductibles on some insurance plans. Indeed, it poses a hardship on our clients.

When industry representatives negotiate an insurance contract for their employees or look for better deals with the various managed care and insurance companies, they search for the best ways to save themselves and their employees money and supposedly hold down health care costs. It’s supply and demand.

Across the board, more of the expense of health care is being turned over to employees. Many are facing higher copays, not only for mental health but for doctor visits as well. It appears the insurance industry is trying to save the companies they represent some money and/or make more profit. We may see more of this. Some of my clients failed to notice the Jan. 1 letters from their insurance plans and were shocked to learn their deductible was now $500 or even $1,000 or their copays increased substantially.

Union plans and very large company plans are still paying as they were. We are watching these trends and will alert our readers to changes. We warn counselors to start each year always asking clients for the full fee for one or two or now three sessions to cover the deductible that has renewed itself each Jan. 1.

Q: We were your room monitors at the ACA Convention in Detroit. We wanted to let you both know that we really enjoyed listening to all of your ideas, thoughts and opinions. We purchased the notebook of information and appreciate everything that is in there. However, there is one thing we were interested in that we can’t find in our notes. One of you talked about purchasing “canned group material” for education purposes. Where did you say that we could find those materials?

A: One very good resource is Impact Publishers (www.impactpublishers.com/). Take a look at the website and scroll around to see all the topics: parenting, marriage, depression, stress, communication, etc. Another useful resource is AGS (check out the website at www.pearsonassesments.com/pa-search/search.asp).

These materials can be used for educational purposes. We recommend them for free public presentations as a service to the community as well as speaker’s topics to market a private practice.

Robert J. Walsh and Norman C. Dasenbrook are coauthors of The Complete Guide to Private Practice for Licensed Mental Health Professionals (www.counseling-privatepractice.com). ACA members can e-mail their questions to walshgasp@aol.com and access a series of “Private Practice Pointers” on the ACA website at www.counseling.org.

Letters to the editor: ct@counseling.org