Featured Articles Don't Get Lost In The Phone Maze Tips When Calling the Health Plan, by Barbara Griswold, LMFT (November 15, 2008) A Civil Rights Milestone: The New Parity Law and What it Means for You, by Barbara Griswold, LMFT (October 15, 2008) A Program That WANTS to Help Your Clients Pay for Your Services?, by Barbara Griswold, LMFT (August 15, 2008) The New PTSD: Pissed at Those Stupid Deductibles, by Barbara Griswold, LMFT (June 16, 2008) 12 Easy Ways to Jeopardize Your License: Surprisingly Common Forms of Insurance Fraud, by Barbara Griswold, LMFT What EVERY Therapist Needs to Know About Recent Insurance Changes: An Update on the National Provider Identifier and HCFA/CMS-1500 Claim Form, by Barbara Griswold, LMFT (August 10, 2007) Don't Get Lost In The Phone Maze Tips When Calling the Health Plan By Barbara Griswold, LMFT (November 15, 2008) It isn't always easy to get through to the right person at an insurance company. In fact, it isn't easy to get through to a person at all. But here are some tips to keep in mind: Reaching Someone with a Pulse What time is it there? Make sure you call during normal business hours in the time zone of the insurance company's headquarters. If you are located in on the West Coast, this may mean calling before 2:00 pm. After-hours staff may have limited ability to help you except in emergencies. When possible, avoid high-call volume periods, such as Monday mornings.   Ignore the options. If an automated message comes on giving you options (e.g. "for the status of a submitted claim, press 1, for claims address, press 2"), try saying "Customer Service," "Representative," "Associate," or "Agent." If all else fails, press "O" or say "Operator."   Do nothing. If you do nothing in response to prompts, you will usually be transferred to a live person (this exists for rotary phone callers).   Avoid the speakerphone. The health plan's Interactive Voice Response system (IVR) and your speakerphone may not work together. Also, the IVR may interpret background noise (voices, sirens, or a dog barking) as your response. A handset or headset may work better.   Slow down. If you attempt to "work ahead" of the prompts, the Interactive Voice Response system might not recognize your answers. Other Phone Tips Allow enough time for the call. A few minutes between clients is typically not enough to unsnarl a claim problem or to check coverage. Running out of time and having to call back will only add to your frustration.   Be ready. To allow access to a client file, the plan rep will ask you for at least two confidential pieces of information about the client, such as her social security number (SSN) or insurance plan ID, and date of birth. Also be ready to give your SSN/EIN and your NPI, if you have one.   Avoid leaving messages. Many plans aren't good at returning calls, and speaking to a live person is always preferable. But if you must leave a message, leave as much identifying information as possible about the client and the issue. Speak slowly and clearly, repeating all numbers and spelling out all names.   Don't take the 'fax back' option. Avoid their offer to fax you a summary of the client's benefits. The answers you need are typically not in these summaries. Also, they may only contain medical coverage information, not mental health, so they can be misleading.   Keep a record of the call. Most plans document all calls, and may even tape record them, which can be helpful if you later need proof they gave you incorrect information. Document the name and the direct phone number of each person you speak to, the date, and exactly what you were told.   Or forgo the phone altogether. While I HIGHLY recommend you call when initially checking insurance benefits, some info can be found at the plan's Web site (ex. claim status, authorization confirmation, etc.). Want more great tips like these? Get the must-have manual every therapist should have. Order now! Just click here [ back to top ] A Civil Rights Milestone: The New Parity Law and What it Means for You By Barbara Griswold, LMFT (October 15, 2008) Thanks to a new law, more than 1/3 of all Americans will soon get better insurance coverage for mental health treatment. Part of the economic "bailout" passed by Congress, The Paul Wellstone and Pete Domenici Mental Health Parity & Addiction Equity Act requires health plans to provide coverage for mental health and addiction treatment that is equal to ("at parity with") coverage provided for the treatment of physical illnesses covered by the plan. WHAT IS THE LAW ABOUT? Once this law goes into effect on October 3, 2009, group health plans will no longer be able to impose limits on inpatient days or outpatient visits or require higher deductibles or copayments for mental illness or addiction treatment that are not also applied to medical treatment. In addition, if a plan allows allows your client to go out of their network of providers for medical care, it must also offer out-of-network coverage for mental health and addiction. BUT WEREN'T THERE ALREADY PARITY LAWS? Congress passed a federal parity law in 1996, but it was very limited. 39 states responded by enacting their own parity laws. But most states (including California) limited their parity coverage to a handful of diagnoses that they considered "severe" or "biologically-based." Also, many health plans were exempt from these state laws, most notably "self-funded" health plans (often sponsored by the largest employers). This new law extends parity to those 115 million Americans not previously granted equal coverage though state laws. HOW WILL THINGS CHANGE FOR MY CLIENTS? 1. For certain clients (who were not previously covered by a state parity law) their deductible may be waived, and/or the co-payment may be lower, meaning they may be able to see you more frequently — and longer — than they otherwise could have. 2. They may now also be eligible for unlimited sessions. Keep in mind, of course, managed care plans reserve the right to review ALL cases for "medical necessity" of treatment. 3. If you live in a state like California where state laws are diagnosis-specific, the covered diagnoses should be expanded significantly. WHAT DO I NEED TO KNOW? 1. Again, the law doesn't go into effect for a year, and some will get extra time to comply, so don't go expecting big changes right away, and some will get extra time to comply. 2. Some plans are exempt, including businesses with 50 or fewer employees, and individual plans. 3. The law does not require a plan to cover specific illnesses, or mental health services at all, but rather applies if a plan does have such coverage for medical illnesses. 4. A plan is not required to cover any particular provider license (ex. MFTs or LPCs). BUT WON'T THIS COST MORE? This remains to be seen. But the Congressional Budget Office estimates that the new law will only increase premiums by an average of about two-tenths of 1 percent. WHY IT IS SO HISTORIC — AND JUST PLAIN AWESOME With the stroke of the President's pen, we now have official government recognition of the clear scientific evidence demonstrating that many mental illnesses are biologically-based, and as such should be treated equally by insurers. It helps stop discrimination against those with mental illness. And, by making treatment more assessable and affordable, it helps lower one of the many barriers that keeps clients from walking through our doors and getting the help they need — and deserve. To learn more about parity laws, visit www.nami.org. To get the manual that answers all your questions about parity and insurance, click here. [ back to top ] A Program That WANTS to Help Your Clients Pay for Your Services? By Barbara Griswold, LMFT (August 15, 2008) We have all seen clients who have been molested, raped, physically abused, or who have been the victims of domestic violence. You probably have also seen a sibling, parent, or partner of someone who has been victimized. But did you know that there is a program that actually WANTS to reimburse you for your sessions with these clients? The Victim Compensation Program (VCP) — sometimes also known as "Victim/Witness" — is a California government program that may help victims and their families pay for crime-related expenses. Benefits include crime-related mental health, medical, and dental treatment. The list of covered crimes is quite extensive, including murder, robbery, physical and sexual assault, neglect, domestic violence, and injuries incurred from a vehicle when the driver is drunk or flees the scene. Some of us have never heard of this great program, or know little about it. Even worse, many of us have avoided working with the VCP due to our colleague's complaints about slow payment and low reimbursement rates. But VCP has worked hard to change. Many therapists now rave about the program's speedy payments and new reimbursement rates — up to $90/session for LMFTs and LCSWs, $110/session for psychologists, and $130/session for psychiatrists. And get this: You don't have to be a Program provider or sign a contract to be reimbursed. In fact, registered MFT interns and social work associates can be reimbursed! They are even reimbursed at the rate allowed for their supervisor.   Program representatives have stated that claims are rarely denied.   While clients are encouraged to apply for the Program within a year of the date of crime, there are acceptable reasons for late application. This means the crime could have taken place yesterday or years ago.   Those who have witnessed crimes are also covered, including children who have witnessed domestic violence.   Undocumented immigrants also may be covered. In fact, a client is eligible for the VCP as long as he/she is a resident of California (and the crime took place in another state), or the crime took place in California.   If a client has insurance, the VCP may reimburse the client for the portion of the session cost that the insurance plan did not pay. Amazing, huh? Like insurance plans, claims must be filed using the revised CMS/HCFA-1500 claim form. (To order these forms, click here.) Many clients (and therapists) aren't aware of this wonderful plan. I know I have seen hundreds of clients who could have benefitted from this program. My ignorance has done these clients a terrible disservice. Look into this — for the sake of your clients. California therapists can visit the Victim Compensation and Government Claims Board (VCGCB) web site at www.vcgcb.ca.gov for general information about the VCP and for the contact number to the Victim/Witness Center in your own county. Out-of-state providers should check their state and county government web sites for similar programs. [ back to top ] The New PTSD: Pissed at Those Stupid Deductibles By Barbara Griswold, LMFT (June 16, 2008) Deductibles may be the most confusing, annoying, and disruptive part of working with any client who seeks reimbursement from their insurance. So even if you have never signed a contract with an insurance plan, this is stuff EVERY therapist should know. What's a deductible? This is the amount that a client with insurance has to pay out-of-pocket before the plan pays a dime. Do all plans have deductibles? Thankfully, no. This is more common if a client sees an out-of-network therapist (one who has NOT signed a contract with the health plan), but many plans have a deductible for all providers. What's changed? In the olden days, deductibles were usually $100, maybe $250 at the most. But lately I have seen clients with $1000, $3000, even an $8000 deductible. No kidding. This coverage is great if you get hit by a bus, but not so great if you have a garden-variety mental or physical illness. Why the increase? Health plans are not making the huge profits they used to enjoy, so have developed this way to shift the high cost of health care to their members. Coupled with ever-increasing premiums and larger copayments (often $30 or $40), therapy is becoming much more expensive for clients with insurance. Why is this so important? Let's look at an example. You are a contracted provider with the client's health plan, which pays you $60 per session. Your client pays her $20 copayment at each session. At the end of the month, you submit a claim. When the Explanation of Benefits (EOB) arrives six weeks later, you get no payment because the client has a deductible of $600. Now ten weeks into treatment, you turn to your client to pay the $400 balance (remember she paid $20 at each session). At the very least your client may be ticked off. Even worse, your client may not be able to pay you, and may drop out of treatment. Worse yet, your client may have already ended treatment in the ninth session, making it harder to collect. What if my client pays in full when she comes? Let's say she submits the bill to her insurance plan, and finds out when the claim is processed that the plan won't reimburse her because of the deductible. She may have counted on this reimbursement when choosing to see you. So she might be annoyed that you didn't give her this important information ahead of time. And if she isn't going to be reimbursed, she may be unable to continue treatment. There's more. Let's return to the example above. As a preferred provider, the plan will only count your $60 contracted rate toward the deductible — you cannot charge more for any session you have with this client. If your client has a $600 deductible, the plan will not start paying until the 11th session. Let's say you are NOT a contracted provider with the plan. In our example, you charge $125, but the plan caps its reimbursement at $80 per session for an out-of-network provider. Due to your client's $600 deductible and this $80 cap, she will not be reimbursed at all until the seventh session. Starting at the eighth session, her plan won't reimburse her for $20 of each session (this is her copayment, the client's portion of the bill) AND won't reimburse the $45 difference between the $125 she paid you and the plan's $80 cap. Final tally? Of the $125 she paid you for the session, she will not be reimbursed for $65 of her payment, or more than half. There's even more. One of my clients has an employer who has chosen a less expensive Blue Cross plan, which pays a maximum of $25 for each session. This means that only $25 is applied to the $600 deductible for each session. This means if your contract rate with Blue Cross is $67, your client will have to pay $67 out-of-pocket until the deductible is used up in the 25th session. After that, her copayment will be $42. Just to make this more annoying, some plans have one deductible that applies to any of the client's medical or mental health visits. But some have a separate mental health deductible, which may be split between you and any psychiatrist or other therapist (e.g. a couples therapist) that the client is seeing. This means the client's visits to medical doctors may not reduce their mental health deductible. One final complication: The deductible usually starts again at the end of the calendar year. This means when your client finally uses up her deductible, the whole out-of-pocket dance will start again in January. Have I completely confused you yet? Have I completely confused you yet? My advice? Remember that even if you've never signed a contract with an insurance plan, this deductible stuff applies to your clients, too. This is one reason I STRONGLY advise ALL therapists to check coverage after the first session. In fact, I often get insurance information on the first phone call, telling my client that I want to be sure there are no surprises for them down the line. After this call, I'll be able to inform a client if there will be no reimbursement for the first session(s). Then your client can decide if she can afford treatment — and you won't be stuck trying to collect for an unpaid session. You will need to ask the plan numerous questions, including whether the client has a deductible, how much it is, whether the deductible varies by diagnosis, how much of the year's deductible has been used, and if this deductible is for mental health only. In my book, Navigating the Insurance Maze, I've included a helpful worksheet outlining 6 questions you should ask clients about their plan, and 12 essential questions to ask the plan when checking coverage. I also explain why you should never trust what the client or her health card says about her coverage. To learn more about handling insurance issues like this that EVERY therapist should know, check out my book Navigating the Insurance Maze: A Therapist's Complete Guide to Working with Insurance – And Whether You Should — just click here — or to order the book, click here. [ back to top ] 12 Easy Ways to Jeopardize Your License: Surprisingly Common Forms of Insurance Fraud From Navigating the Insurance Maze: The Therapist's Complete Guide to Working With Insurance — And Whether You Should by Barbara Griswold, LMFT Most of us became therapists because we want to help people. In all our years of coursework, we may never have taken a class in running a small business, or in dealing with insurance plans. Because we may not be well-informed about the financial aspects of our practices, we can end up making decisions that we don't even know are illegal or unethical. In some cases, our resentment about insurance contract restrictions and discounts may cause us to be less than completely honest in our billing. After all, you may feel, these big insurance plans can afford it, and no one will find out. In other cases, you may bend the truth in a well-intentioned attempt to assist your clients, to help them afford therapy. "Some of these practices have become so commonplace that many healthcare practitioners forget that what they are really doing is misrepresenting their services to insurance companies solely for the purpose of getting reimbursed," writes Mary Riemersma, Executive Director of CAMFT1. So how exactly do we know we've left the territory of trying to help clients, and entered the territory of insurance fraud? Michael Brandt, a fraud investigator for HealthNet Insurance, writes that "health care fraud is deception or misrepresentation by providers, employers, members, or any person acting on their behalf with knowledge that the deception could result in some unauthorized payment or benefit2." Notice that this definition includes people "acting on your behalf," such as billing services or clearinghouses you have hired. Here's a quick rundown of some common fraud traps that are easy to fall into: 1. Choosing or changing a diagnosis for the purpose of expediting or guaranteeing payment. Giving a diagnosis when none exists. It is fraud to submit a claim giving a diagnosis of a mental illness when one does not exist in order to gain reimbursement. This may be especially tempting if a client (or couple) seeks counseling for issues related to self-esteem, communication, career, or personal growth, but there is no mental illness present (as classified in the DSM or ICD). You may be aware that typically health insurance plans will not cover sessions when there is only a V-code diagnosis. If you do choose a diagnosis, be confident you could defend it later to an insurance company representative, or in court, if it came to that. Document the symptoms that back up your diagnosis in your case notes.   Changing Diagnosis: It is sometimes tempting to give the client a more serious diagnosis than they actually have when you know this will afford them better coverage for treatment. For example, if you knew that with a diagnosis that is included in state parity laws (such as Major Depression), your client might pay a lower copayment or get unlimited sessions, you might think about changing his diagnosis. Your client may even ask you to do this. But this is insurance fraud. In other cases, such as when the client has a "pre-existing condition" clause, insurance may exclude coverage for a particular condition that was present before their coverage began. Changing the diagnosis to "get around" this clause is also fraud. "A diagnosis should not be changed unless a mistake was made in the original diagnosis or unless the patient's condition has changed," says Riemersma3.   Under-diagnosing: For example, your client may not want to document his substance abuse, but it could be considered fraud if you instead diagnosed him with an Adjustment Disorder when that is not what you are treating. Why? Because the insurance plan might have made different authorization or reimbursement decisions if they knew the correct diagnosis. Also, problems could also arise if there are discrepancies between your treatment notes and your billing diagnosis. 2. Billing insurance for cancelled or missed sessions without making it clear that the appointment was missed. While it is permissible to bill for a missed appointment, you must make it clear on the claim that the client did not attend the session — don't use a CPT code that would give the impression that a session took place. However, most insurance companies will not pay for cancelled sessions or no-shows; check your contract (if you are a network provider) or call the insurance plan. If you are allowed to bill for missed sessions, ask the insurance plan what CPT code to use on your bill or claim. Be sure "missed" or "cancelled" is clearly indicated on the claim. Remember that some insurance contracts do not allow you to bill clients for missed sessions; others allow it when the client has signed a written agreement in advance to pay for missed sessions. 3. Charging insurance more than your usual fee. In your practice, you need to have a designated "full fee" that you charge to clients. This doesn't mean you need to abandon your sliding-fee scale: It is OK to slide down from your usual fee, just not up when billing insurance plans. While this is not an issue for network therapists, who have a contracted fee, if you are an out-of-network therapist, it may be tempting to charge insurance companies more per session than your full fee. But it would be fraud, for example, to charge Jack's insurance $150 per session if you have never charged a self-pay client this much — you would be misrepresenting your actual fee. 4. Waiving client copayments or co-insurance in advance. You may not bill the insurance plan for sessions and tell the client he doesn't need to pay his copayment or deductible. Say your usual fee is $100, and you know your client's co-insurance is 30 percent ($30), but you agree in advance to waive his portion. In essence, this is agreeing to see him for $70 but billing insurance for $100, which is fraud. Does this mean you can't offer sliding-scale fee? Not at all. If you want to assist a client in affording therapy, you might choose instead to slide your fee to $50, cutting Jack's out-of-pocket portion to $15. But in this case you should bill the insurance plan only $50 per session. Keep in mind that waiving copayments in advance is not the same as forgiving balances the client has left unpaid. The latter is acceptable if you have made reasonable attempts to collect, and as long as the debt wasn't waived at the beginning of treatment. 5. Billing for writing reports or treatment summaries, or for consultations with other providers, using a therapy CPT code. Most insurance companies will not reimburse for administrative time, training, or consultations and many won't allow you to bill your client for them. Check your contract (if you are a network provider) or call the insurance plan. If you are allowed to bill insurance for these services, use appropriate CPT codes, not those you use for therapy sessions. If your contract with the health plan allows you to bill your client, be sure your client agrees in writing and in advance. 6. Reporting that you provided individual therapy when you saw a couple, or vice versa in order to be paid for the session. You must clearly identify who attended the session on the billing form. Let's say you are working with Jack and Jill as a couple, but at one point you want to see Jill alone. Jill would have to be the identified client for this session, and have a medical diagnosis, and you would need to be sure she was covered. She might also need her own treatment authorization. You may not bill Jack's insurance in any way that would give the impression that Jack was present in the session (e.g., listing Jack as the client and using the CPT code for a couples or individual therapy session). In another example, if your authorization is for individual therapy for Jack, but you bring in Jill for a couples session, you may not falsely give the impression on the claim form that you had an individual session with Jack. 7. Providing a couples therapy session, and billing both partners' insurance companies for an individual therapy session. Because the CPT procedure codes are different, this would be misrepresenting the service provided. You may bill both insurance companies for couples therapy, but you would need to bill the primary insurance first, and secondary insurance after the primary has paid, letting each insurance plan know about the other's coverage and payments. 8. Having someone else sign your claims, or having interns or associates sign in a way that might make them appear licensed, in order to assure reimbursement. If you have a license which is not covered under the health plan, you may not have a psychiatrist or covered license holder sign for you. The consequences for misrepresenting the service provider can be severe, including jail time, community service, repaying the insurance company, money damages, and potential loss of license. Interns and associates are not covered by most insurance plans. If the insurance company does reimburse interns or associates, the treating therapist and supervisor should both sign, identifying themselves on the claim as "treating therapist" and "supervising therapist." 9. Billing two insurance companies for the same service(s) with the intent to collect your full fee from both of them. The bottom line? You may not collect more than your full fee for any given session. 10. Rewriting case notes before an insurance case review, audit or appeal. This is equivalent to falsifying documents, and you may be guilty of insurance fraud. 11. Billing for services you didn't provide. This may not be as obvious as it seems. This could include billing for missed sessions or phone sessions as if the client attended. 12. Changing service dates. You may be tempted to change session dates on the claim, for example, in order to be covered by a particular authorization that has since expired, or back-date sessions because a client has since lost coverage. Or if you know the insurance plan won't cover the two-hour session you provided, you might submit a bill for two separate one-hour sessions on different days. However, reporting that you saw a client on a day you didn't is insurance fraud. "Do not allow yourself to be misled or manipulated by your clients who convincingly ask for your assistance in reducing their financial burdens at the expense of their insurance companies," writes Mary Riemersma. "You are the therapist, the one in control of the situation, and you should be the role model. The costs to you as the therapist can be very great should you be charged with insurance fraud or some other violation of law4." In addition, from a clinical perspective, you would be essentially entering into an illicit conspiracy with your client against the insurance company, an agreement which could taint the therapy and the therapist-client relationship. References: 1. Mary Riemersma, "What is Insurance Fraud?" The California Therapist, (March/April 2001). 2. Michael Brandt, "Health Care Fraud Affects Everyone." Health Net Physician News (Spring 2000), p.7. 3. Riemersma, "What is Insurance Fraud?" 4. Riemersma, "What is Insurance Fraud?" [ back to top ] What EVERY Therapist Needs to Know About Recent Insurance Changes: An Update on the National Provider Identifier and HCFA/CMS-1500 Claim Form By Barbara Griswold, LMFT (August 10, 2007) Major changes are happening in the insurance industry these days. As you may know, insurance plans are transitioning to the use of a new claim form, the revised CMS-1500 (version 08/05). After 17 years of use, the old form is being retired since there is no place for providers to report their National Provider Identifier (more about this below). This new form was going to be required as of April 2007, but when the government accidentally sold an unknown number of misaligned forms, the date was pushed back — several times. So, do I need to start using the new form now? Most government plans are now requiring the new forms. But individual insurance carriers are each making their own timeline as to when they will begin rejecting the old form (the CMS-1500, version 12/90). For example, Blue Cross of California will be accepting either form until 1/2008. Other plans I spoke to (including CIGNA and United Health Care) were accepting both forms, and had not yet set a date for when the new forms would be required. However, I am told that a few plans have begun to reject claims filed on the old claim forms. Where can I purchase the new forms? The new forms can be purchased on this Website’s order page (click here) and at some office supply stores. Large quantities (usually 1000-5000 copies) can be purchased through some online form outlets. TO ORDER the new forms and specially-designed CMS-1500 envelopes, click here Where can I get instructions for the new form? You can go to the National Uniform Claim Committee Website (www.nucc.org), click on “1500 Claim Form” in the tool bar, and download all 50 pages of instructions. Or better yet, pick up a copy of my book Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance — And Whether You Should, where I’ve synthesized the information you’ll need to know into five quick-reference pages, along with a case example and completed sample form. Order Now! Will I need to submit forms on the original red-inked forms, or are copies OK? Insurance companies strongly prefer that claims be submitted on original red-inked forms, and this has a benefit for you. Using the original form allows the insurance company to use computer scanners to process your claim, which can greatly speed your payment. One note: don’t try printing your own forms with your printer’s red ink — it isn’t the same color! Is it OK to submit handwritten claims? Health plans strongly recommend (and some may soon insist) that your claims be typewritten or computer-printed. According to Brad Lotterman of United Behavioral Health, “UBH receives more than 2,000 illegible handwritten claims a day” (Psychotherapy Finances, December, 2006). Even if legible, the health plan’s scanners may not be able to read handwritten forms. These claims require hand-processing, and delays your payment. If you don’t have a typewriter (does anyone anymore?), you may want to invest in inexpensive billing software so you can print out claims. There are many programs that only print claims, are simple to use, and priced for less than $100. Type “CMS-1500 Claim Form Filler software” into your search engine for some software programs. So, what is a National Provider Identifier (NPI)? Do I need one? The NPI is a single provider identification number assigned to you, designed to replace the different provider identification numbers assigned by each health plan with which you do business. I would advise all therapists to get an NPI, even if the therapist is not covered by HIPAA. Why? Because several insurance company representatives I spoke with said that claims would not be paid without a provider NPI — even for those therapists just mailing or faxing a paper claim, or giving an invoice to our clients! CAMFT is also recommending that all members get an NPI. An NPI is free to get, but can be costly not to have. While government health plans already require the NPI, individual health plans are setting their own deadlines. For example, Blue Cross of California has said they will accept either the NPI or provider’s license number on claims until 1/2008. How do I get my NPI? Getting your NPI is easy and free. It takes about 15 minutes at https://nppes.cms.hhs.gov/NPPES (or call 1-800-465-3203). Does using my NPI on claims mean I no longer need to use my tax ID number? No. Your tax ID is still needed for income tax reporting. If you are uncomfortable using your Social Security Number, apply for an Employer Identification Number (EIN) — it’s free and you can apply online at http://www.irs.gov/pub/irs-pdf/fss4.pdf. Can information on my NPI application be viewed by insurance plans and certain other agencies? Unfortunately, yes. You may not want to put your home address or phone number on the application. If you already did, you may go in to your NPI file and change this. If I get an NPI, does this automatically make me a “HIPAA covered entity,” so that I have to go through all the other steps of HIPAA? No. There is no such duty. I am filing claims for sessions several months ago. Should I use the new form? If the health plan is accepting the new form, yes. Can I still use the old form if I don’t have an NPI? No, sorry — everyone will need to use the new form. Conclusion? Get your NPI, get the new claim forms, and call the insurance plans you work with to see what their transition timelines for both the NPI and the new claim form are. Many companies have policy information like this on their Websites. Barbara Griswold, LMFT, is the author of Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance — And Whether You Should. E-mail barbgris@aol.com, visit her Website at www.navigatingtheinsurancemaze.com, or call 408.985.0846 to purchase the book or the new forms, to find out about upcoming workshops, or to get answers to your insurance questions. Copyright 2007, Barbara Griswold, LMFT. No part may be reproduced without written permission of the author. TO ORDER the new forms and specially-designed CMS-1500 envelopes, click here [ back to top ] TO RECEIVE BARBARA'S FREE MONTHLY INSURANCE E-MAIL NEWSLETTER, CLICK HERE (Your information will remain confidential.)